Inspection on 22/07/08 for Willowcroft

This inspection was carried out on 22nd July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Willowcroft 03/09/07

Willowcroft 08/01/07

Willowcroft 23/01/06

Willowcroft 31/08/05

Willowcroft 15/03/05

Willowcroft 27/10/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Willowcroft Odstock Road Salisbury Wiltshire SP5 4JL Lead Inspector Sally Walker Key Unannounced Inspection 22nd July 2008 09:30 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 Willowcroft DS0000028288.V366645.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. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willowcroft Address Odstock Road Salisbury Wiltshire SP5 4JL 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) 01722 323477 01722 325947 manager.willowcroft@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust Mrs Marilyn Crothers Care Home 42 Category(ies) of Dementia - over 65 years of age (21), Learning registration, with number disability over 65 years of age (1), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (21) Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum 21 places Dementia aged 65 years and over on admission- Code DE(E) maximum 21 places Learning disability aged 65 years and over on admission- Code LD(E)maximum 1 place Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission- Code MD(E)- maximum of 1 place The maximum number of service users that can be accommodated is 42. 3rd September 2007 2. Date of last inspection Brief Description of the Service: Willowcroft is registered to provide personal care for 42 older people aged 65 years or older, 21 of whom may have dementia. The home was purpose built by the local authority in the 1970’s. The accommodation is to two floors offering communal space on each floor. The home provides all single bedroom accommodation. A large well maintained garden is to the rear of the building. The home is situated on the south side of the city of Salisbury, close to all amenities and facilities that Salisbury offers. The registered provider is the Orders of St Johns Care Trust. The Registered Manager is Mrs Marilyn Crothers. She came into post in April 2007 and was registered on 17th July 2007. The care staffing rota provides for a minimum of one care leader and 4 staff during the mornings, a care leader and 3 staff during the afternoons and evenings and 3 waking night staff. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Pharmacist Inspector and the link Inspector carried out this unannounced inspection. It took place on 22nd July 2008 between 9.20am and 5.35pm. Mrs Crothers was present during the inspection. We brought this Key inspection forward as we were given information about medication errors that had not been notified to us. We were also given information about concerns over pressure area care. These areas were our priority during this inspection. As part of the inspection process we sent survey forms to the home for people who use the service, relatives, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. We asked Mrs Crothers to complete an Annual Quality Assurance Assessment. It was completed in full and returned on time. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home ensures that as much as possible is known about the care and support needs of people who are considering using the service so decisions can be made about whether their needs can be met. The assessment considers people’s social needs as well as medical and personal needs. Mrs Crothers ensures that people who may have a period of time in hospital are well enough to return to the home. People have good access to healthcare professionals. People are consulted about who provides intimate personal care. The part time activities co-ordinator provides a good range of group and one to one activities with people. The organisation provides a range of different social events for people in all its homes. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 6 People are encouraged to contribute to menu planning. People tell us that they enjoy the range and quality of the meals provided. The home is cleaned to a good standard. Procedures are in place for infection control. People have good relationships with staff. Staff have good access to relevant training. What has improved since the last inspection? What they could do better: The format for assessing people’s risk of developing pressure damage must state which score necessitates referral to the district nurse for advice. The nutritional assessment outcome score must relate to the nutritional section in the pressure damage risk assessment. The exact time of administration of medication prescribed to be taken ‘as required’ must be recorded to ensure that the correct gap is left between doses. Staff must ensure that they follow the organisation’s policies and procedures for safe administration and control of medication. Checks must be made against the medication administration record when administering medication prescribed to be taken once a week. The home must ensure that people’s stocks of medication do not run out. Staff must comply with current legislation with regard to storage, administration and recording of controlled medication. People must not be put at risk by some staff’s poor practice when giving medication. A thorough investigation must be carried out as to why Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 7 medication errors are continuing despite updated training and reviewing of continued staff competence. We must be notified of all events that affect the safety and well being of people who use the service. This is required by regulation. The care staffing rota must show who actually worked. Consideration should be given to continual monitoring of the amount of hours that activities are provided so that people’s social needs are fully met. Consideration should be given to continual monitoring of staffing levels so that they are appropriate to meeting the needs of people who use the service. This should also taken into consideration duties, other than care, that staff are expected to provide. 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. Willowcroft DS0000028288.V366645.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 Willowcroft DS0000028288.V366645.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. Standard 6 does not apply as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home carries out detailed assessments with people who are considering the service. This means that all aspects of their care, support needs and social life are known before a place is offered. EVIDENCE: Action had been taken to meet the requirement we made that an appropriate pre-admission assessment document is in place. This means sufficient information can be gained from people who are considering the service and from their carers, to enable a care plan to be written up before the person is admitted. The organisation has produced new pre-admission assessment documentation. In the AQAA, Mrs Crothers told us that she or the head of care would carry out the assessments. Mrs Crothers told us that if people who use Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 10 the service have a period of time in hospital, she would carry out an assessment to ensure that the person was well enough to return. We saw that recently admitted people had received a detailed assessment before their admission to the home. The home is also requesting a social history from people who are considering the service and their families to aid the assessment process. One of the people who use the service told us “I am very pleased I moved to Willowcroft. I was made most welcome.” Willowcroft DS0000028288.V366645.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 adequate. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made to fully recording people’s personal and healthcare needs and how they are to be met and monitored. People have good access to healthcare professionals. People are not always protected by the home’s policies and procedures for the safe handling of medicines. The home does not always tell us of events which adversely affect the well being and safety of people. EVIDENCE: Staff had put in much effort to transfer all the peoples’ information to the new care planning format. Action had been taken to address the requirement we made that all care needs are recorded in peoples care plans. We said that care plans must also include guidance on how those assessed needs are to be met and monitored. The organisation’s new format comprised sections for care plans and risk management together with monitoring forms and daily records. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 12 Mrs Crothers told us that she had written many of the care plans so that staff knew what aspects of care and support should be recorded. We saw good evidence of managing one person’s diabetic condition. We saw that one person who was regularly weighed had lost weight over a period of time. The care plan showed this was noted at the review but just stated ‘but no problems’. The person had seen their GP during this time but it related to a chest infection. Action had been taken to meet the good practice recommendation we made that individual entries on body maps should be dated for monitoring purposes. We saw that individually dated forms were completed to record each wound or mark. We saw one body map that stated ‘a small bruise’ with no detail as to size or colour. Other body maps were more detailed. We had been given information about concerns over pressure area care. At the last three inspections we had made a requirement that assessments must be carried out of people’s risk of developing pressure sores. During these inspections we had been given assurances that the organisation was producing a new tool to assess tissue viability. This is now in place. The home had three different managers during this time, so new timescales had been set for them to address the matter. In the AQAA Mrs Crothers told us that the new assessments were reviewed monthly or when necessary. She also told us that two people had developed pressure sores which had now healed well. Mrs Crothers told us that staff are receiving tissue viability training. She said that further training had been promised by the Primary Care Trust once the new Tissue Viability Specialist Nurse was in post. Mrs Crothers told us about her re-assessment of people who may have a period of time in hospital. She said that she carries out full assessments of those people’s tissue viability status. She had also met with the district nursing service. As a result different ways of working together have been established. The district nurses now hold two clinic days at the home. Action had been taken to meet the requirement we made that nutritional assessments are in place to monitor people’s dietary needs. The organisation has introduced new formats which staff were completing. We noted that the outcome score in the nutritional assessment form did not relate to the nutritional element of the pressure risk assessment form. We also noted that the pressure risk assessment form did not identify when the district nurse must be notified. However the nutritional format did state when the district nurse must be alerted. Some scores were ticked rather than numbered. We noted in the records that staff were very prompt in alerting healthcare professionals when pressure points had started to be compromised. However there was little evidence of preventative measures. Staff told us that one pressure sore had healed. There was pressure relieving equipment in place where indicated. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 13 We looked at one person’s care plan. They were described as having a visual impairment. There were details about equipment the person used for orientation and keeping up to date with news. However there was little detail of how the person was kept informed of events in the home. One of the care leaders told us that staff had been given information about people with a visual impairment in training and supervision. We advised that information was also available on the Royal National Institute of Blind People’s website. The care plan showed good detail of support needed with personal care. We noted that some of the ladies had facial hair. We were told that it was their choice not to have the hair removed. Those people we spoke with told us that they generally had a bath when they wanted. One person told us that their keyworker would suggest having a bath when they came on duty. The majority of people we visited in their bedrooms had their call bells and a drink within easy reach. One person’s call bell was on the wall on the opposite side of their bedroom. A jug of water and a glass was on a trolley on the opposite side of the bedroom. We asked them how they would summon staff. They told us about using the call bell and they said they could get to the bell and to the drink. We saw evidence in care plans that people had been consulted about their preferences of the gender of staff providing intimate personal care. We had been given information about medication errors. The home had not notified us of these errors as required by regulation. Prior to this inspection our Pharmacist Inspector was asked to inspect records taken from the home. These records showed 2 separate occasions where prescribing instructions had not been followed, resulting in overdose. It appears that the person suffered no ill effects. These records also showed that one person had not been given a medication for 3 days as the home had not anticipated that stocks were running out. Since this time there have been 3 further mis-administrations of medication. We were informed at the time. One of these notifications identified the same member of staff identified previously. They were only suspended from administering medication after the second error. On two of these occasions staff had given medication on the wrong day. The head of care informed us of these events whilst Mrs Crothers was on leave. The head of care also carried out an initial investigation as to why the errors occurred. These staff had not been suspended from medication administration. The head of care reported that the daily diary now gave instructions on the different days for administration. Care leaders were instructed to check that the administration instructions were adhered to. In the AQAA Mrs Crothers told us that there had been 4 medication errors in the last year due to human error and poor communication. She told us that all Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 14 staff had been trained even if they were not administering medication. She had also asked the organisation’s director of nursing and another home manager to do an independent audit to supplement the home’s own monthly audit. Staff’s ongoing competency was regularly checked. At this inspection our Pharmacist Inspector looked at arrangements for the handling of medicines. Medication was stored securely and records kept of all medicines received into the home and returned to the pharmacy. Printed medication administration records are used and all changes are signed and checked. These records were correctly completed with signatures or codes as appropriate. However the records for medicines prescribed ‘as required’ were not clear as to the time of administration. Clear care plans were in place for all medicines prescribed in this way. Since the errors were noted, staff have had training in medication practices from the local pharmacy and the home’s management. We saw care staff administering medication in a safe and caring manner. Controlled drugs are recorded appropriately, however the storage of these medicines needs to be reviewed in line with current legislation. Staff were seen to administer these medicines in a way that did not comply with safe practice as the record was made after the administration. We noted that this medication was not in the controlled medication cabinet. We found that staff had taken it with them on the drug trolley rather than administer it from the cabinet and checking against the record. We advised that an investigation should have been carried out immediately the errors we had not been told about occurred, to establish the reasons. The staff responsible should have been removed from administering medication until they were deemed competent. Strategies should then have been put in place to ensure there was no repeat of poor practice. Since this inspection the home has informed us of a further medication error. They have told us that the staff responsible has been suspended from giving medication until investigations have been carried out and they have undertaken further training. Mrs Crothers informed us that she will now assess this staff’s competency to continue to give medication. One of the people who use the service told us that staff put prescribed drops in their eyes. They told us staff always administered the drops on time. Another person told us how they had benefited from a reduction in medication in consultation with their GP and consultant. We could not determine whether the good practice recommendation we made that unused or unwanted medication should be entered into the disposal log at the time it becomes discontinued. This was because the record was reported to be with the supplying pharmacist. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 15 One person in a survey form told us: “I have found the care and support extremely good and this has kept me in good health.” Comments in a relatives survey form included: “It cares for the individual”. Another relative told us: “Mum seems very happy at Willowcroft occasionally she might have a little moan to me, but nothing serious. She suffers with dementia so I study her very carefully ensuring that all her needs are met, and that she is happy with all the staff.” Comments in a staff survey form included: “I know when I first joined Willowcroft care plans – insufficient information, now I feel there is far too much paperwork.” Comments in healthcare professionals surveys included: “We have made recommendation in the past about how to look after their patients. Communication is poor between the staff and the advice has not been handed over. The standards have slipped recently but we are working to improve the nursing care that we have requested from them. Too many new staff. Need more education on pressure area care, bowel care, catheter care, skin care. We ask that a carer comes round with the nurses whilst we visit patients. Patients/individuals are socially looked after very well, they have lots of activities going on in the home. [Could improve?] Educate carers.” Other comments were: “Contact with primary care appropriately to deal with pressure area care etc. Polite, caring and friendly to residents, family, visitors. [Could improve?] Communication with families regarding their relatives well being etc. Communication with CMHT. OSJ maintain that they are EMI registered. But when service users go for respite etc. home unable to cope with EMI peoples, saying the care staff have experience but still unable to cope. Lack of EMI units.” Three GPs responded to our survey forms. One GP commented: “Willowcroft are generally very good. My only comments are:- sometimes they are too quick to call for assistance rather than acting on their own initiative. I get the impression this is to protect themselves. The home is generally well run and communication is good.” Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. The home makes sure that they know about people’s interests and lifestyle. People are encouraged to maintain contact with family and friends. People’s access to the events in the locality is improving. People are encouraged to make decisions about how they spend their day. People enjoy a varied range of meals produced with fresh local ingredients. Efforts are made to include people in developing the menus. EVIDENCE: Those people who could decide spent their day as they wished. Other people relied on staff for direction. In the AQAA Mrs Crothers told us that they do not automatically presume people want to see visitors. We saw staff asking people in the dining room what they wanted to do that morning. We also saw the activities co-ordinator asking people if they wanted to join in with the planned activity. Those who did not want to join the group Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 17 were asked what else they wanted to do. Some were given art materials or word searches. Some action had been taken to address the good practice recommendation we made that the amount of hours provided for activities continues to be monitored. Mrs Crothers told us that she had put forward an increase in these hours in the budget requests but it had not been approved. Currently there are 20 separate hours allocated to activities. However the weekly activities programme, posted on the notice boards at different points around the home, shows activity events for the mornings, afternoons and evenings, seven days a week. It was clear from speaking with the activities co-ordinator that a range of stimulating activities was provided during the 20 hours a week. At other times care staff are expected to provide activities. There were separate advertisements for art therapy, holy communion, keep trim and the garden club. It was evident from the minutes of the ‘residents meetings’ that the activities co-ordinator had discussed what they would like to do in the way of activities and trips. The activities co-ordinator told us about the different group and one to one activities they offered. They said they provided one main activity each day. They planned to take some people fruit picking. They would then make summer pudding with the fruit. Some people had also decorated biscuits. The Activities co-ordinator told us that they had received training in first aid, moving and handling and medication so that they could administer if needed when out on a trip. They told us they kept records of individual peoples involvement in activities. They said they were also required to carry out monthly evaluations of these records. They had made some games for people to be involved in, for example, a horse racing game. They had a monthly budget to purchase materials. Some people had been to a local pub for lunch. One person told us that they liked to join in with the activities. They told us they liked to do puzzles, games, art and word searches. They said they also liked to read. They told us that they had recently been to one of the other homes in the organisation to a beetle drive. They told us that staff had held a car wash to raise money for the home. Another person told us that they had been on a trip to the New Forest. Another person showed us photographs of their visit to a tea dance at one of the other homes in the organisation. There are a range of inter-home activities provided by the organisation. The home has the use of a minibus owned by a nearby home to attend these events. One person whose first language is not English told us about going to their church. Mrs Crothers told us that each home in the organisation was putting together different boxes of items that could be used as reminiscence therapy. These boxes would be exchanged with each home for their use. Mrs Crothers also told us that a canal trip was being planned. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 18 Mrs Crothers told us that the process of establishing peoples’ social histories with them had brought unexpected positive outcomes. One example was reuniting someone with family who had lost contact. There was a small shop where people could buy toiletries, sweet or drinks. Those people we spoke with told us that their visitors were made welcome and could visit at any time. Some people told us that they could have their meals either in the dining rooms or in their bedrooms. It was clear from the minutes of the ‘residents meetings’ that the chef had discussed the menu choices with them. We saw the menu board in the upstairs dining room. The daily choice was written on a blackboard in chalk. The writing was very faint. We asked several people if they could make out what had been written. They all had to go up close to the board to see the menu. We advised that consideration should be given to ensuring the menus are better advertised. We saw that the serverys on each floor were kept locked. We spoke with one person who made themselves drinks in the servery. They said they knew the code to open the door. They said they could make themselves a drink whenever they wanted. Other people were supplied with drinks and biscuits during the morning and afternoon. All of the people we spoke with told us they enjoyed the meals. One person told us they did not like stews and that they were given meat alternatives. They told us that the chef knew what they liked. One person told us they were pleased to have recently put on weight. We looked at the menus. A range of traditional meals was provided with at least two choices for each meal. A salad was provided as an alternative. The lunch menu was roast beef or tuna bake with shortbread and lemon cream for pudding. The chef told us that the menus were newly compiled taking into consideration what people had told them. There was a cooked breakfast offered each Wednesday and Saturday. The chef told us that the majority of the ingredients were fresh, locally sourced and cooked ‘from scratch’. We saw that the majority of the biscuits and cakes were made in the kitchen. The chef told us about the different tasting sessions they had held with different groups of people. They had tasted different sausages from the local butcher. There had also been cheese and wine tasting. The chef told us they had taken the tasting to some people who preferred to stay in their rooms. The chef told us of the recent development day held by the organisation. The focus had been on nutrition and fortifying meals for those who needed extra protein. She went on to say that the milk used was now full fat and cream was added to the porridge. They talked about food supplement drinks being available. Some action had been taken to meet the good practice recommendation that the meal choices were shown to people rather than trying to remember what Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 19 they had ordered the day before. We said that other homes in the organisation enable people to choose at the table. We found that when we arrived at the home staff were asking people what they wanted to eat for lunch and the evening meal for the next day. Then at lunch time we saw staff showing two different plates of food. We asked Mrs Crothers why people were still having to say what they wanted to eat the next day. She told us that it was so that sufficient quantities of each dish could be estimated. The lunch was served according to individual appetites. It was well presented and looked appetising. There were bowl of fresh fruit on each of the tables in both dining rooms. Action had been taken to meet the good practice recommendation we made that consideration should be given as to whether it was appropriate to leave some people in wheelchairs at the dining table. This was because we saw that some could not reach the meals due to the arms of the chair not fitting under the table. We only saw one person in a wheelchair at the table. We talked with them and it was clear that they were an independent wheelchair user in their own designated chair. One person told us in a survey form: “I like to attend the church service and communions which I find very important. I also attend the residents meetings which provides us with up to date news at Willowcroft and to give our own views and opinion on many important issues that take place. I enjoy the meals very much and there is a varied menu everyday. The cooking is excellent and in addition we enjoy a variety of cakes at tea time. There is a special Birthday care for the residents which is excellent and greatly admired on their Birthday.” In a staff survey form the activities co-ordinator told us: “When residents are asked to participate in an activity they normally decide for themselves. [Induction?] Visited [another home in organisation] and spent 10 days working alongside the activities co-ordinator. Found it most interesting and informative for my future. We cover a range of social activities within the home – physical, cognitive and sensory. Trips to outside venues are a recreational activity. It is an extremely rewarding job and I look forward to going every morning. The staff are extremely helpful when I am organising an activity and much support for trips, entertainers, fund raising activities is given by my manager.” Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place for people and their families to make comments and complaints about the service. Staff are confident that they will use the local safeguarding adults procedure to report any allegation of abuse. People remain at risk through some staff’s poor practice in administration of medication. EVIDENCE: In the AQAA Mrs Crothers told us that people who use the service have access to a local advocacy service. Mrs Crothers told us that there had been 2 complaints in the last year; 1 not upheld and 1 not concluded. One of the people we spoke with told us that they did not know how to make a complaint when we asked them. They went on to say that there was nothing that they were unhappy with and had no complaints to make. In the AQAA Mrs Crothers stated that all staff have a copy of the local safeguarding procedure booklet entitled ‘No Secrets in Swindon and Wiltshire’. Staff are trained in this procedure at induction and there is an e-learning module on safeguarding adults. Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 21 We asked different staff about what they would do if they witnessed any abusive behaviour. They were all familiar with the safeguarding adults reporting process. These staff told us they had been given copies of the booklet entitled ‘No Secrets in Swindon and Wiltshire’. This inspection was brought forward as we had been given information about medication errors that had not been notified to us as required (see Standard 9 above). Despite re-training and competence monitoring a further error has occurred since this inspection. One person told us in a survey form: “I would always speak to [the manager or the administrator] if I had any problems. They have always been very supportive to me and we have a special understanding between us.” Comments in a relatives survey included: “Have never had any problems”. Comments in a staff survey form included: “If home manager not available I am able to try and resolve or give the relevant information, i.e. yourselves if necessary.” Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. People are benefiting from improvements to the environment. Plans are in place to further improve the environment for people’s comfort. The home is cleaned to a good standard and fresh smelling. EVIDENCE: All of the bedrooms are single accommodation to the ground and first floors. Bedrooms are individually personalised with people bringing small items of furniture. Many people told us they had keys to their bedroom doors. In the AQAA Mrs Crothers told us that all of the communal areas had been redecorated following discussions with people who thought these areas ‘shabby’. Eleven bedrooms had also been redecorated and re-carpeted. Other Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 23 improvements included: toilets and bathrooms refurbished and fitted with nonslip flooring, passenger lift refurbishment, new curtains in some communal rooms, a new sensory bath and new dryers in the laundry. There are further plans to refurbish bedrooms, purchase new armchairs and replace fencing in the garden. The hairdressing room had been refurbished into a salon-style room. There were 2 housekeeping staff on the morning of the inspection. One was carrying out deep cleaning of some carpets. We talked with the staff responsible for laundry duties. They explained how the laundry was organised and processed. They said they worked from 9am to 1pm from Monday to Friday. Care staff are expected to carry out laundry duties in the afternoons and at weekends. The member of staff told us that they had recently undertaken training in fire prevention, moving and handling, and infection control. They explained the process of dealing with soiled or infected linen. They also told us that staff would inform them if any infections were present. One of the people who use the service told us that their washing was collected every day and returned promptly. Another person told us “they keep this place lovely”. In the AQAA Mrs Crothers told us that a head housekeeper had been appointed and that there are robust procedures for infection control. We did not notice any unpleasant odours at any time during the inspection. A designated room had been provided for people who smoked. One person in the room told us they either used this room or went outside in the better weather. Many people were sitting outside. Patio furniture and sun umbrellas had been provided. Mrs Crothers told us of the plans to improve the gardens. Comments in a relatives survey form included: “Any mishaps by residents are always dealt with quickly in order to diminish any odours.” Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some increase in support staff hours means that care staff can concentrate on providing care. Staff continue to be busy and are expected to carry out other duties as well as care. Some staff are putting people at risk by poor medication administration. Staff have good access to relevant training. People are protected by checks on staff’s suitability to work with vulnerable people. People have good relationships with staff, especially their keyworkers. EVIDENCE: Mrs Crothers told us that there had been a significant turnover of staff in the last six months. Some staff had retired. A head of care had been appointed from one of the care leader’s hours. Some action had been taken to meet the good practice recommendation we made that staffing levels continue to be monitored so that they are appropriate to meeting the needs of people’s individual dependency levels. We said that the review should also include tasks and other duties that staff are expected to carry out. We looked at the staffing rota. On the day of the inspection there were: the head of care, a care leader and 4 care staff during the morning. A care leader and 4 care staff during the afternoon and evening. At night there are 3 waking night staff. We looked at the rota for the previous weekend. We saw that there had only been Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 25 4 care staff on duty during Saturday evening. Mrs Crothers told us that in fact there had been 5 staff. We advised that the rota must be a record of who actually worked. In the AQAA Mrs Crothers told us that care hours had been increased by 15 hours a week. There was also a 20-hour care support post. This person does not provide personal care. They make beds and assist with serving meals. During the inspection Mrs Crothers told us that she intended to provide another 20-hour care support post. We sat with some people in one of the sitting rooms on the first floor. From discussions and observations we concluded that due to their specific care needs, they would not necessarily be able to use the call bell to summon care staff if needed. We also spent time on the ground floor in one of the corridors. We noted that the only staff who were present in these areas were two housekeepers carrying out deep cleaning of carpets and staff serving refreshments. We saw that care staff were busy supporting individual people with washing and dressing. This meant that they did not necessarily have time to monitor those people in the different communal areas. The activities coordinator was working with people in the dining room downstairs. We noted that staff did engage with individuals as they were going about their work. It was clear that good relationships have been developed. Staff are also expected to carry out laundry duties. One of the recently appointed care leaders told us about their previous experience in care. They said they were an NVQ Assessor. They told us they had received a good induction into their role and that they had shadowed a member of staff until their Criminal Records Bureau certificate had been received. They told us they were a trained trainer in moving and handling and would be training other staff in this area. They had received training in care planning, supervision, medication and compiling rotas, since their appointment. In the AQAA Mrs Crothers told us that the head of care was undertaking NVQ Level 4. Two staff were undertaking NVQ Level 3 and 2 staff were doing Level 2. Fifteen of the 31 care staff have attained NVQ Level 2 or above. This meets the standard in that over 50 of staff have NVQ Level 2 or above. We looked at staffing records. Generally the home has a robust recruitment process. One member of staff had only one reference. This was not in relation to their previous appointment in care. We saw that any issues noted on receipt of Criminal Records Bureau certificate were investigated before appointments were made. No staff commenced duty until their suitability to work with vulnerable people had been confirmed. In the AQAA Mrs Crothers told us that there is comprehensive induction training for all new staff. This included modules on equality and diversity. All new staff complete the Alzheimers Society training in dementia care. Ancillary staff have a half days Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 26 training in dementia care. Some staff had attended a conference on dementia care. Mrs Crothers stated that a resource centre had been set up for staff’s professional development. We could not inspect the staffing training and induction records as they are held electronically and the home’s internet line was not functioning. We were told that all staff had received training in the organisation’s policies and procedures for the safe handling of medication. However there continue to be medication errors by some staff. All of the people we spoke with made very positive comments about the staff, particularly their keyworkers. One person in a survey form told us: “I speak very highly of all the carers who are very kind and dedicated to their work. I have great support from the staff and especially my Key Worker [named]. She is thoughtful and very caring, which means a great deal to me.” Comments in a staff survey form included: [could improve?] “In a perfect world more care staff spending, fun time with the residents, more one to one.” Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Crothers has many years experience of providing care and management to older people. She is clear about her plans to develop the home. Quality assurance systems are in place. Staff have regular supervision. Systems are in place to monitor people’s health and safety. EVIDENCE: Mrs Crothers was registered as manager in July 2007. She has many years experience of providing care to older people, both as a provider and manager. Mrs Crothers has completed NVQ Level 4 in management and care. In the AQAA she told us that she expects to complete the Registered Managers Award Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 28 within 6 months. Mrs Crothers told us that she had recently attended training at a local hospice in palliative care and an ‘end of life’ course was booked for the end of July. Mrs Crothers told us that the organisation had recently carried out a quality audit of the home. She would compile an action plan for addressing the findings. Mrs Crothers holds regular meeting with people who use the service every 2 months. Minutes of these meetings were posted on notice boards. Care leaders, the activities co-ordinator and the chef are present at these meetings to hear peoples’ views. Mrs Crothers also holds regular meetings with the different staff groups. Action had been taken to meet the good practice recommendation we made that all documents should be signed and dated for monitoring purposes. We did not look at standard 35 regarding the arrangements for people to hold small amounts of cash in the home’s safe on this occasion. At the last two inspections we found that there were satisfactory procedures in place, well managed by the administrator and regularly audited. All staff receive regular updated training in moving and handling, fire safety, first aid, food hygiene and infection control. Any risks to people are recorded in their care plans. The home has a handyman who deals with day to day maintenance and repair. The organisation has contractors who deal with regular servicing and maintenance of equipment. The home did not inform us of two medication errors that were reported to us. This is required by regulation which states that we must be informed of any events that affect the health and wellbeing of people who use the service. the regulation also included informing us of misconduct of any person who works at the care home. Comments in a relative’s survey form included: “Feel it is very important to keep Willowcroft to the high standard that it is currently run at.” Willowcroft DS0000028288.V366645.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 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 30 No 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 OP9 Regulation 13(2) Requirement Administration records for medicines prescribed ‘as required’ must contain the exact time given to ensure that the correct gap is left between doses. Staff must all follow the procedure for the safe administration of controlled drugs so that a correct record is made at the time of administration. This must also include checking against the record for different days of the week that medication is prescribed. The home must ensure that sufficient stocks of medication are ordered. A controlled drug cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 must be purchased and installed. The registered person must ensure that CSCI is notified without delay of any incident, which affects the well being of a DS0000028288.V366645.R01.S.doc Timescale for action 29/09/08 2 OP9 13(2) 23/07/08 3 OP9 13(2) 31/10/08 4 OP8 37 23/07/08 Willowcroft Version 5.2 Page 31 5 OP9 6 OP27 OP37 person. The person registered must ensure that thorough investigations are carried out with regard to reasons for ongoing medication errors despite staff training and competency monitoring. 17(2) The person registered must Schedule ensure that the care staff rota is 4 para 7 & an accurate record of who 18 (1)(a) actually worked. 13(2) & (6) 31/08/08 23/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The Registered person should continue to monitor the amount of hours that activities are provided within the home to ensure that the social needs of the service users are fully met. The Registered person should continue to monitor the staffing levels ensuring that the staffing levels are appropriate to meeting the needs of the service users dependency levels. The review should also include tasks and other duties that staff are expected to carry out. All written documents should be signed and dated for monitoring purposes. Consideration should be given to unclear statements in records, for example, ‘a small bruise’ and ‘but no problems’. The nutritional score in the pressure damage risk assessment should relate to the outcome score in the nutritional risk assessment. Unused or unwanted medication should be entered into the disposal log at the time it becomes discontinued. Prepackaged medication should be returned in its packaging and blister packs should be returned unopened. (We could not establish whether this was being completed as the records were with the supplying pharmacist). DS0000028288.V366645.R01.S.doc Version 5.2 Page 32 2. OP27 3. 4 5 6 OP37 OP37 OP8 OP37 OP9 Willowcroft Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willowcroft DS0000028288.V366645.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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