CARE HOMES FOR OLDER PEOPLE
Willowcroft Odstock Road Salisbury Wiltshire SP5 4JL Lead Inspector
Sally Walker Key Unannounced Inspection 09:05 8th January 2007 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.V305403.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.V305403.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 The Orders Of St John Care Trust Sarah Jane Hill 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.V305403.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The maximum number of services who may be accommodated at any one time is 42 No more than 21 service users in the category Old Age may be accommodated at any one time No more than 21 service users with dementia over the age of 65 years may be accommodated at any one time The only service user who may be accommodated in the home with a learning disability aged 65 years and over is the male service user currently in residence in that service category The only service user who may be accommodated in the home with a mental disorder aged 65 years and over is the male service user currently in residence in that service category 23rd January 2006 5. Date of last inspection Brief Description of the Service: Willowcroft is registered to provide personal care only for 42 older people aged 65 years or older, 21 of whom may have dementia. The home is purpose built with 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 Sarah Hill. She came into post in March 2006 and was registered on 19th September 2006. The care staffing rota provides for a 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.V305403.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days between 9.05am and 6.15pm on the 8th January and between 9.20am and 4.40pm on the 9th January 2007. The majority of the requirements from the previous report of 23rd January 2006 had been actioned. The inspection was prior to Mrs Hill coming into post in March 2006. As part of the inspection process comment cards were left with the home for residents to complete and the views of relatives and GPs were sought. One of the relatives said that they were very happy with the care that their parent received. Another relative also said they were happy with the care and that the food was good. They said staff had enabled their parent to cope with a newly diagnosed condition. Another relative said “I have no concerns about the quality of care provided to my [parent]. Whenever I visit the staff seem so busy it’s a wonder they have time to draw breath.” One of the residents said “I think they are understaffed for the residents that they have now. But they do their best. I prefer to stay in my room & read, cross words or watch TV.” Another said “I refused to sign up to a contract whereby I’d pay [a top up fee]. Still sometimes the side/bread plate has the high tea meal on it. Although I am rarely very unhappy, I do not know who to see if I am.” One of the GPs said “I have no particular concerns with the level of care at Willowcroft. I generally find the staff to be helpful and caring.” Regarding comment cards: one resident said they had not received a contract. One resident said they had received enough information before moving to Willowcroft and one said they had not. One resident said they always received the care and support they need and one said they usually did. One resident said that staff listened to them and acted on what they said. Two residents said that staff were usually available when they were needed. One resident said that there were sometimes activities that they could join in with but bingo they found “low brow”. Two residents said they usually liked the meals provided. One resident said they knew who to complain to and another said they did not. Two residents said that the home was usually fresh and clean. 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. The fees for the home are between £370.57 and £470.00 per week. Residents are required to pay for personal items such as toiletries, hairdressing and chiropody.
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The long-term care document had stopped being used as a pre-admission assessment document as it was not suitable for this purpose and could not be easily used to gain information with prospective residents prior to admission. Care plans were now being written by staff. Mrs Hill was clear that it was not the manager’s responsibility. She was supporting staff to enable them to complete accurate and effective care plans. Some action had been taken to ensure that the care plans of residents who used the respite service had their care plans fully reviewed on the day of admission. However staff need to go back to the original pre-admission assessment to ensure that respite care residents’ care needs are fully documented in the first place or start afresh with a new pre-admission assessment. Several of the documents that had been removed from residents’ files at the request of the organisation had now been reinstated, following a requirement at the last inspection. The keyworker document in the form of a tick list, was
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 7 no longer used as staff were recording more fully their input in the daily reports. Tissue viability training had been sourced from a local district nurse as a specialist nurse was not available in the area. The training will assist staff to assess the initial indicators associated with potential risk of residents developing pressure sores. The organisation had installed a computer so that all staff can assess the e-learning package to access training including induction. All staff were expected to undertake dementia training. However this was the only training in dementia and related subjects being offered. The home now ensures that medication prescribed following a GPs visit is immediately obtained with the prescription being faxed to the supplying pharmacist or staff driving to the duty pharmacist if out of hours. Eye drops were now being dated with the date of opening. Stock medication had been reduced to a minimum. The self-administration risk assessment was now being completed and regularly reviewed to ensure the safety of that resident. There was now evidence of good investigation and appropriate response to complainants on file. The organisation is gradually improving the comfort of the environment for residents with carpets being replaced, new furniture, some improved bathrooms and redecoration. Mrs Hill has requested that the remaining bathrooms and toilets are brought up to the same standard with replacement furniture. The arrangements for the storage of dirty laundry and cleaning of the laundry had improved. Twenty-five care support hours had been allocated to the home by the organisation to support care staff with serving meals and some housekeeping. Care support staff would not be involved in providing personal care. The employment files now contained proof of staff identity as required. All staff now have regular supervision. What they could do better:
The majority of the organisation’s pre admission assessment documents are a number totalling system mainly for funding purposes. These forms do not allow staff to gather sufficient information with which to develop an initial care plan. These documents only refer to dementia and not mental health for which the home has one bed registered. These documents would not assist an assessor in determining the difference in either condition. However as the staff who carry out the assessments have a degree of skill in knowing what to ask of potential residents and others involved in their care, sufficient verbal information is available to start the care planning process. Staff also make their own notes. Although work had been done to improve the information in care plans, more work needs to be done to ensure that all needs are documented. The care
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 8 plans must include clear guidance to staff on how to meet those needs and evidence of any monitoring of progress. The care plans must be reviewed and revised as needs change, not just each month. It is essential that information in parts of the care plan do not conflict with information in other parts of the care plan. Staff should ask healthcare professionals reasons for any blood or urine tests that they may carry out and record their findings. Care plans must detail how medical conditions are to be managed and by whom. Although staff were identifying some risks to residents of developing pressure sores, there was not sufficient evidence to show that staff had a full understanding of preventative measures. This should improve once tissue viability training has been carried out. There was good evidence that appropriate measures were put in place once the district nurse was alerted when red marks appeared. This is often too late if residents’ risk is high. Staff need to record evidence of progress of healing of any wounds with detail of size, colour and whether the skin is broken. Although no nutritional assessments were in place, staff were recording whether some residents had eaten different meals and food supplements were available. As nutritional risk is part of good tissue viability, record should improve once training has occurred. Some residents said that there were not sufficient staff to offer them a bath more than once a week or when their keyworker was on leave. There was other evidence to suggest that current staffing levels in all areas were not sufficient. Cleaning and laundry hours only covered the mornings mainly during the week resulting in areas being missed and not being cleaned to infection control standards. A system must be instigated to ensure that commode pots are cleaned or sterilised as they are taken from rooms. They must not be left to soak in the sluices en-mass so that it is difficult to establish which commode pan belongs to which resident. Only 20 hours were allocated to activities. Care staff were expected to carry out cleaning, laundry and activities at other times, taking them away from care. Care staff also had delegated areas of administrative duties, which were not necessarily always identified on the rota as separate from their caring role. It is however recognised that Mrs Hill has requested extra care hours of the organisation in her budget request. A recommendation was made at the last inspection that staffing levels were reviewed. It is also recognised that Mrs Hill was implementing co-keyworking in order to retain continuity in keyworkers absence. A small number of staff need to consider how they enter residents’ private space by knocking and waiting to be invited into bedrooms. 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. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The organisation’s pre-admission assessment documents are for funding only and do not allow for sufficient information to be gained about the often complex care needs of potential residents. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The requirement that the long term care document was not used as a preadmission assessment document as it was not fit for this purpose had been actioned. However the other three documents provided by the organisation did not support staff to complete comprehensive assessments of potential residents. Two of these documents were in the form of a tick list and were essentially a fee setting tool. The documents did not give sufficient information to inform the care plan. The documents referred to dementia but not mental health so did not assist the assessor in determining the differences in these diagnoses. Discussions were held with regard to staff being diligent in ensuring that the admissions process took into account the categories for which the home is registered. Mrs Hill said that new documentation was due to be implemented by the organisation. One of the residents said they had visited the home to see if it was suitable before deciding to move in. One of
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 11 the staff discussed the assessment that they had carried out in the local hospital. It was clear that staff know how to carry out complex assessments to ensure that potential residents care needs can be met and that sufficient information, albeit verbal, is relayed to staff in order to compile a care plan. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Although work has been done to improve the detail in residents care plans, some care needs were not identified and others had no action plan or monitoring systems. Residents had good access to health care professionals. Some residents were able to administer their own medication. Staff had good relationships with residents but not all respected their private space. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: All of the residents had a care plan which generally identified their care and support needs and how they were to be met. Although it was clear that much work had been done to improve information provided in the care plans there is still some work to do in regularly reviewing and revising the plans to ensure they are up to date. Whilst personal and social care were well documented the care plans did not always show how residents health care needs were identified, met or monitored. It was reported that the previous manager had written and updated all the care plans and care staff were still getting used to doing this themselves. Mrs Hill said she was discussing compilation of care plans in staff supervision. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 13 The requirement that when a resident was re-admitted to the respite service that the care plan was fully reviewed on the day of admission had been actioned in part. One resident who was using the respite service did not have the length of their stay documented or whether a keyworker had been allocated. There was no pre-admission assessment on file although there was a pressure risk assessment and a moving and handling assessment dated a week before admission. There was information about a medical condition with no reference to how it was managed. One resident was identified as not being able to read or write but their care plan made no reference to how staff were supporting them with information, signage or other written information. Another care plan gave conflicting information in that it stated that one resident was bathed by their family yet their pressure damage risk assessment stated that staff would check for pressure areas when bathing them. One part of this care plan stated daily baths and another part stated weekly baths. There was no evidence that staff always asked medical professionals why blood or urine tests were being carried out. Where a medical condition had been diagnosed its management was not always identified in the care plan. One resident who said they had diabetes described how their condition was regularly monitored by the district nurse. They said that staff brought them a sandwich and a biscuit last thing at night with a hot drink and again in the morning before their breakfast. They said they were confident that staff understood diabetes and would know what to do if their condition deteriorated. This residents care plan identified how their condition was monitored. However another resident who said they had diabetes did not have a fully comprehensive care plan with regard to their condition. The care plan did not identify whether the district nurse or staff were monitoring their blood sugar levels. Further investigation showed that staff were monitoring and had completed a list of the results. However the care plan did not identify the parameters for this resident or what action to take if sugar levels rose or fell. The care plan stated that weekly blood tests were carried out yet the monitoring chart showed gaps of 23 and 10 days between recordings. There was no mention of diet preferences in this resident’s care plan. The inspector discussed the compilation of effective care plans and the purpose of regular review with 2 of the care leaders. There was very good observed evidence that staff had a good understanding in managing behaviours. There was also good evidence of consultation with others involved in residents care when completing risk management assessments. Mrs Hill said that none of the current residents could bath alone. One resident said that their keyworker was on sick leave and they had to ask for a bath. Another resident said that staff did not have time to offer them more than one bath a week. Mrs Hill reported that she was implementing a co-keyworker
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 14 system. This should ensure that a second member of staff was responsible for the keyworker role in any holiday or sick leave. The requirement that the keyworker document was used as residents had made reference to the keyworker relationship was now no longer relevant. At the time that the requirement was made, several documents had been removed from files by the organisation and this meant that the records did not fully support all the care needs of the residents. The keyworker document was a tick list of personal care and keyworker input. The care plans and daily report now evidence the care and keyworker input with more detail. The requirement that assessments were completed with regard to residents’ risk of developing pressure damage was in progress. Some care plans identified risks to residents but did not fully evidence that staff had a good understanding of all the indicators of potential risk. There was evidence that all appropriate measures were put in place once marks appeared on residents bodies, but there was little evidence of preventative measures. Mrs Hill and the organisation’s training manager had sought tissue viability training from one of the district nurses as the Salisbury area does not have a tissue viability specialist nurse. The training programme was due to start in January 2007 and would continue each month. Mrs Hill reported that she had asked for specific training that related to the care and support of the current residents. This included medication and infection control. One of the residents was reported to have returned from hospital with a pressure sore. The district nurse was treating the wound. The care plan stated “sore on heal” but no indication of its exact location or which foot. The medical appointments file stated “sore on bottom” and again no indication of its exact location and nature or of progress in healing. It was clear from talking to staff that they were aware of the exact nature of the wound and the inspector advised them to keep more exact records. The inspector advised that body maps would augment records of progress with healing of any wounds. Body maps were available for some marks and wounds but not this pressure sore. The inspector also advised that a record must be kept of the size, shape, depth and colour of wounds as evidence of healing. The home must keep its own records and not rely on those of the district nurse. There was evidence of pressure relieving equipment in place and food supplements were prescribed. The requirement that nutritional risk assessments were carried out to fully monitor residents dietary needs had not been actioned. As this should be part of the tissue viability assessment process, with staff having an understanding of the part that nutrition plays in tissue viability, it is expected that the home will implement these once the training has been carried out. There was some evidence in the daily report of staff recording what residents were eating. Food supplement drinks were noted in the medicines room. There needs to be Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 15 more detailed evidence that individual nutritional need is assessed with a strategy for improving nutrition and evidence of ongoing monitoring. Two care leaders had the delegated responsibility for the administration and control of medication. One of them explained the system and showed the arrangements for storage of medication. The requirement that the resident who was self medicating had a risk assessment which was regularly reviewed for their safety had been actioned. Residents may administer their own medication following a risk assessment. The care leader said that it was mainly people who used the respite service and that the residents GP would always be consulted regarding their views on their patient self-medicating. Staff cannot administer medication until they have received training and had their competence assessed by one of the care leaders. Staff continued to be assessed as to their ongoing competence to administer medication. Records were kept of the receipt and return to the supplying pharmacist of any unused or unwanted medication. The care leader said that no homely remedies were kept; if residents requested cold remedies or other homely remedies then their request would be referred to their GP. Some care plans identified that some residents took paracetamol when required. There was no record of why this was prescribed or what prompted a dose to be given. No controlled medication was prescribed. The requirement that the home’s procedure for obtaining and commencing medication following a GP visit was reviewed had been actioned. The home now either faxes the prescription to the supplying pharmacist before 2.00pm and the medication will be delivered, or staff will drive to the duty pharmacy to have the prescription filled. The requirement that all eye drops were dated from the time of opening had been actioned. The recommendation that the amount of stock medication kept in the home was observed had been actioned. The stock was now reduced to a minimum. As a matter of good safe practice it was noted that all the wheelchairs had their footrests attached so reducing the risk of residents being moved without their feet dragging on the floor. All of the residents were well supported in their personal care choices with clean clothing, teeth, spectacles and nails. It was clear that staff ensured that residents looked nice throughout the day. All of those residents visited in their bedrooms had their call bells within easy reach and a drink nearby. Residents said that they could access their GPs through their keyworker or other staff and they were never refused a visit. They said they saw their GPs in the privacy of their own bedrooms. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 16 The organisation does not have a policy on intimate personal care being provided by staff of a different gender. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The organisation provides only 20 hours each week for activities over 4 days. Care staff are expected to provide events at other times. This time allocation does not enable all 42 residents to be supported in individual interests or access local facilities. However some group activities were available most days. Residents said their friends and family could visit at reasonable times and they were always made to feel welcome. Those residents who are able to choose can retain choice and control over their lives. Residents are provided with a very good range of choice meals based on healthy eating and geared to residents’ preferences. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: When the inspector arrived at the home on both days, it was evident that residents had a leisurely breakfast. Those residents who could decide for themselves were able to spend their day as they wished and follow their own routines. One resident said they could have a lie in bed without being ill. Another said they could spend their day in their room watching television. One resident said they normally got up at 5.30am as was their habit. Other residents relied on staff to explain any events that were taking place and decide what to do. It was noted that staff visiting those residents who may have a visual impairment did not introduce themselves to those residents when entering their bedrooms although they did explain the purpose of their visit.
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 18 The recommendation that the amount of hours provided for activities was continually monitored to ensure the social needs of residents were fully met remains. The home still only provides 20 hours over 4 days for activities for 42 residents each week. Mrs Hill said that she intended to develop the range of activities provided. Some activities included bingo, a coffee morning and small trips out in the locality. The home also engaged in the events organised between other homes in the organisation in the locality. Some of the residents confirmed that they had been to other homes to quizzes and a tea dance. One resident said they went to a local church each week. One resident said that their social worker took them out every Wednesday. Another resident said that there had been activities over the Christmas period but things had quietened down since. Residents and their visitors can make drinks whenever they want in the small serverys on each of the floor. Residents said that visitors could come anytime and were always made welcome. Mrs Hill reported that one of the office computers would be made available to residents to use the internet. A payphone booth was available to residents although the majority had their own telephone lines linked to the bedrooms. The home had its own hairdressing salon. The home had a designated smoking room for the only 2 residents who smoked. Staff had to smoke outside. A small shop contained toiletries and sweets and was available to residents on request. Most of the residents said that their keyworker or family would do their shopping. One resident did their own shopping in Salisbury. Residents with a visual impairment had talking books and newspapers. There was no evidence that activities were geared to people with a visual impairment. There was little evidence that positive outcome activities were considered for those residents who may have a dementia. The menus for the day were displayed in each of the dining rooms in large letters. There was a choice of 2 main courses. All of the residents spoken with said they enjoyed the quality of the meals provided. One resident said that there was always something that they liked on the menu. Residents could have their breakfast in their rooms or in the dining room. Mrs Hill had ordered more small tables so that more of the residents could take up the option of having their breakfast in their rooms if they wanted. A cooked breakfast had recently been introduced which many residents liked. Residents said they were asked what they would like to eat the day before and some could not remember what they had chosen. However at lunchtime the meal list had apparently been mislaid so residents were asked what they would like as the meal was being served. There should be no reason why residents could not be asked to choose their meal every day as it is served. Lunch was seen on the first day and the evening meal on the second day. The meals were well presented and served in portions suitable to residents’ individual appetites. The majority of the meals were home made as were the cakes and puddings.
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 19 The majority of the vegetables were cooked from fresh. All of the residents who were visited in their rooms had a drink near them. Staff brought hot drinks in the morning afternoon and evening. Residents were asked about having drinks in the night. The majority said they would not ask for a drink in the night. However one resident who said they were often awake during the night said that they could not have a drink at night. This was discussed with Mrs Hill who was very clear that residents could have drinks and snacks at anytime of the day or night. She said she would remind the night staff to offer residents drinks if they could not sleep and discuss at the residents meetings. Fresh fruit had been provided around the home following a request by residents at one of their meetings. Willowcroft DS0000028288.V305403.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Systems and policies were in place to enable residents and others to make complaints about the service or refer allegations to the vulnerable adults process. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home follows the organisation’s complaints procedure which is displayed on different notice boards around the home. One resident said that they had made a complaint to Mrs Hill and that she had dealt with their concerns to their satisfaction. Another also said they had spoken to Mrs Hill and that she had sorted out a problem they had had. Mrs Hill kept a record of complaints together with good evidence of investigations, outcomes and response to complainants. Staff had had training in managing allegations of abuse. Mrs Hill said that some staff had had experience of the local vulnerable adults procedure but unrelated to this home. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The organisation is gradually improving the quality of the environment for residents with replacement carpets, new furniture, bathroom furniture and redecoration. Current housekeeping staffing levels with minimal cover during the afternoons, evenings and weekends means that not all areas are cleaned to infection control standards. Only 20 hours is provided for laundry duties each week and care staff are expected to take on laundry and cleaning duties at other times. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Residents’ rooms were comfortable, clean and personalised. Small items of furniture could be accommodated if space allowed. Discussions had been held at previous inspections about the condition of the dining room carpet. This has now been replaced, significantly improving the quality of this area for residents. Mrs Hill reported that the organisation’s surveyor had visited to consider the outstanding refurbishment issues. These included damage to one of the servery worktops and redecoration of the upstairs dining room following the laying of a new carpet. Mrs Hill had put in a request to the organisation for
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 22 the refurbishment of some of the bathrooms and toilets. She had also ordered new blinds for the majority of these rooms. The requirement that correct procedures were in place for the storage of dirty laundry and for the cleaning of the laundry had been actioned. The visible areas of the home were generally well cleaned. There were no unpleasant odours detected at any time during the inspection. However it was noted on a tour of the home with the manager, that none of the toilet surrounds and bath hoist seats had been cleaned underneath for some time. They had yellowish and brown drip marks underneath. This included a toilet surround that was found in a storeroom. It was also noted that some of the commode pots were soaking in a disinfectant in the sluices. There was no way to establish whether individual pots were returned to the same residents to avoid cross infection. Mrs Hill reported that staff should know that this practice was poor. She went on to say that the machine normally used for sterilising the pots had broken down. Mrs Hill said she would order new commode pots and ensure a system where pots were cleaned individually and returned to the same resident. The sluice bowls had a build up of lime scale and were heavily stained. The lower shelving in the upstairs servery were in need of a deep clean. Mrs Hill reported that infection control training was due to be held the following week and she would also bring these matters up with the cleaning staff and the staff with designated responsibility for infection control. The housekeeping staffing provision was for weekday mornings only with minimal support at the weekends. At other times care staff were expected to deal with spillages and do the laundry. If the laundry person was on leave, care staff were expected to cover the duties. One of the residents said that they had been told that they could not lock their bedroom door at night to prevent another resident from entering because of fire safety. Mrs Hill was clear that residents could have keys to their rooms and lock their doors at night as staff had master keys to access rooms in an emergency. The door had a spigot so that the residents could lock the door but exit in an emergency without the use of a key. The residents was advised to discuss the matter either with their keyworker or Mrs Hill. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Current staffing levels in all posts do not fully support the input in all areas required of staff. All staff were expected to undertake a training package supplied and assessed by the Alzheimers Society. However there was little further training in this area. Staff were trained in core subjects. Evidence of robust recruitment practices are now in place. The Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The recommendation that staffing levels were continually monitored to ensure they were appropriate to meet the needs of the residents dependency levels remains. However a care support post had been created by the organisation for 25 hours a week. This person would help with serving meals and some housekeeping; they would not carry out personal care. Mrs Hill was recruiting for a total of 45 vacant care hours. She also reported that she had included increased staff establishment hours in her business plan and budget for the coming financial year. The care staffing rota provided a minimum of 4 care staff with a care leader during the mornings and 3 care staff with a care leader for the afternoons and evenings. There was much evidence that current staffing levels did not always meet residents’ needs. For example, as well as carrying out cleaning and laundry when designated staff were not available, care staff at the weekend were required to serve the evening meal at weekends. Care leaders are counted on the care rota. However they can achieve little personal care contact with residents as they run the shifts, administer medication, deal with visitors and are expected to do a degree of delegated administrative duties. One of the residents said that there were not
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 24 sufficient staff to offer them more than one bath a week. A relative commented that staff always seemed so busy. Although staffing levels were minimum, it was clear that staff concentrated on ensuring residents were well groomed as a matter of pride. Staff were also seen to have good relationships with residents, with the majority respecting their private space and engaging with residents. All of the residents spoken with made very positive comments about the staff, particularly identifying keyworkers. One resident said the staff were lovely and kind. Another resident explained how the staff had helped them regain their independence. Two staff were seen to enter 2 residents bedrooms without knocking or waiting to be invited in. Mrs Hill said she would take this matter up with staff. The organisation’s training manager was carrying out an audit of the training for the home. The organisation had installed an e-learning package for staff of which 4 had registered. Staff could access the package from their home computers and the manager could monitor their progress. The training manager explained the training plan for the following 6 months for all the homes in the Wiltshire area. Courses were held around Wiltshire so that staff had better access to training than before. The training manager said that all new staff had a period of induction both in the home and at the organisation’s headquarters. The training manager showed a list of which training was provided centrally and which training must be accessed locally by the manager. The training manager said that the organisation was in the process of approving equality and diversity training. All care staff were expected to attend the dementia training which consisted of 2 days training and a multichoice questionnaire marked externally by the Alzheimers Society. Support staff also had access to the half day training course on dementia. Given that half of the beds are registered for people with dementia, there were no plans for ongoing training from different sources, including external, on a range of related subjects for the rest of the year. Mrs Hill had a matrix showing which staff needed to do core training depending on their role; first aid, fire marshal, health and safety. The home had its own moving and handling trainer. The requirement that all employment files contained proof of identification had been actioned. The organisation has a checklist for the recruitment process to ensure that all documents and information is collated on file. Willowcroft DS0000028288.V305403.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 36 Mrs Hill has a strong sense of how she expects to develop the home to improve the quality of care and support to residents. The home is run in the best interests of the residents. The organisation has robust systems for ensuring residents finances are safeguarded. Staff are now appropriately regularly supervised. The Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Mrs Hill had been in post since March 2006 and was registered as manager in September 2006. Previously she had worked as a care leader in another of the organisation’s homes. She has had over 7 years experience of working in care for older people. Since taking over the running of the home Mrs Hill has done much to address the number of outstanding requirements. Mrs Hill attends training provided by the organisation. She recently attended a video seminar by a nationally recognised expert in dementia care.
Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 26 Residents are encouraged to manage their own finances. Otherwise residents will be directed to families or solicitors. The administrator collected a very small amount of pensions for some residents. Records were kept of these transactions including payment of the maintenance fee and the personal allowance given to the residents. Residents may keep a small amount of cash with the home for safekeeping. Senior staff, the administrator and the manager have access to the cash accounts. Records and receipts were kept of all transactions. The administrator and the manager regularly carried out a full audit of the monies. The administrator was familiar with the local vulnerable adults procedure with regard to possible financial abuse. The requirement that all staff were provided with regular supervision had been actioned. There was an organisational chart showing that the manager supervised the care leaders who then offered supervision to the care and support staff. As part of the home’s quality assurance system suggestions boxes had been placed around the home. Mrs Hill also had regular residents meeting to discuss issues. Many of the residents confirmed that they attended these meetings and that suggestions would be followed up. Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 27 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X X Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered person will ensure that a pressure area risk assessment is completed for all residents. This requirement is outstanding from the 2 previous inspections. However some progress had been made and a further timescale has been agreed as training has finally been secured. 2. OP7 15 The Registered person will ensure nutritional risk assessments are in place to fully monitor service users dietary needs. This requirement is outstanding from the last inspection. However a further timescale has been agreed as tissue viability training is to be carried out. The Registered person will ensure that when a service user is re admitted to the home for respite care that the care plan is fully reviewed on the day of admission.
DS0000028288.V305403.R01.S.doc Timescale for action 31/03/07 31/03/07 3. OP7 15 08/01/07 Willowcroft Version 5.2 Page 29 Some progress had been made but these care plans must include all assessed needs. 4. OP3 14 The person registered must ensure that an appropriate preadmission assessment document is in place in order to gain sufficient information from potential residents and their carers so that a care plan can be established. The person registered must ensure that all care needs are recorded in residents care plans, including guidance to staff on meeting those needs and how progress is monitored. The person registered must ensure that full details of wounds or marks are regularly recorded to monitor progress of healing. The home should keep their own records and not rely on district nursing notes that may be kept at the home. The person registered must ensure that all areas of the home are cleaned to infection control standards, particularly those areas not immediately visible. The person registered must ensure infection control guidance is always followed regarding the cleaning and supply of commode pots. The person registered must ensure that a programme of varied dementia training is available to staff. This should include outsourced training and seminars from specialist dementia providers and experts. 08/01/07 5 OP7 15 08/01/07 6 OP7 17 08/01/07 7 OP26 13(3) 08/01/07 8 OP26 13(3) 08/01/07 9 OP30 18(1)(i) 31/03/07 Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 30 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. The person registered should ensure that where healthcare professionals are carrying out blood or urine tests that the purpose of these tests are recorded. 2. OP27 3 OP8 Willowcroft DS0000028288.V305403.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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