Inspection on 06/02/07 for Willowdene Care Home

This inspection was carried out on 6th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Willowdene Care Home 05/02/09

Willowdene Care Home 17/03/06

Willowdene Care Home 21/12/05

Willowdene Care Home 03/11/04

Willowdene Care Home 15/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Willowdene Care Home Lizard Lane Sedgefield Stockton On Tees TS21 3ET Lead Inspector Bridgit Stockton Unannounced Inspection 13:30 6 February 2007 th 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 Willowdene Care Home DS0000059169.V311744.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. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willowdene Care Home Address Lizard Lane Sedgefield Stockton On Tees TS21 3ET 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) 01740 623644 P/F Maria Mallaband Care Homes Limited Mrs Lynne Margaret Smith Care Home 48 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (36) of places Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th March 2006 Brief Description of the Service: Willowdene provides residential care services for up to 36 persons in the category of OP (older persons) and for up to 12 persons in the category of DE(E) (Dementia Elderly) residing in the Maple Suite. The Home is a modern two story building with the benefit of a lift between the floors along with a single floor annex known as the Maple Suite. The home is situated on the B 1278, about half way between Sedgefield and Fishburn, and lies within its own grounds. Although situated in a rather isolated position, with no shops or other amenities close to the home, there are frequent buses to local villages and major towns and cities in the area ( eg Durham, Sunderland) with a bus stop immediately outside the home. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a period of 4 hours on the 6th February 2007. The home did not know the inspection was going to take place. The plan for the inspection was to check whether the home had implemented the requirements and recommendations made at the previous inspection; to talk with the residents about living in the home; to meet with care staff and the home’s management team; and to look at records. A pre inspection questionnaire had also been returned to the Commission along with some service users surveys. Some of this information has been included within this report. What the service does well: What has improved since the last inspection? Since the last inspection a conservatory has been built, the service users decided on the décor, furniture and flooring. The room looked really nice and was well used by service users. Several communal areas and service users bedrooms have been refurbished and redecorated. An existing bathroom has been converted into an assisted shower facility. The manager is about to introduce individual meetings with all service users and there representatives, so that care plans can be reviewed to ensure that each service user is getting the right level of support and care that is required from the home to meet their needs. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 7 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 Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 8 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): 1,2,3&6 Quality in this outcome area is good. Prospective service users can be assured that their needs are appropriately assessed prior to admission to the home and that they are given sufficient information to make an informed choice before moving into the home. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide have been updated. These guides contain information that is required to enable people to make an informed choice about where to live. Evidence was seen that service users or their representatives have signed a contract with the home. The contracts were detailed and included a breakdown of the fees and who was responsible for paying them. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 9 The manager confirmed that visits to prospective service users always takes place before their admission to the home, to carry out an assessment of needs. Four care plans examined contained notes from assessments made on these visits. Also, each service users care plan contained assessments from the placing authority that were responsible for commissioning the service users care at the home. The home does not provide intermediate care. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. Good systems are in place to ensure that health care needs of the service users are met. Service users can be confident that their privacy and dignity is protected and that they are treated with respect. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A service user plan has been developed for each service user that identifies needs associated with health and personal care. This ensures that staff are clear about what is required of them in meeting service user’s needs. The care plans of four service users were inspected. They were comprehensive and well written. Careful and thoughtful strategies to address particular needs or problems of some service users were well documented and sensitively written. There was evidence of involvement of specialist healthcare people such as the community psychiatric nurse, the dietician and continence nurse. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 11 The management and administration of medication is carried out appropriately and audited by the manager and area manager on a regular basis. Staff were seen to be treating service users with respect and dignity and this was also reflected within the care plans. Service users said that the ‘girls are kind’ and ‘I have nice friends here’. A relative commented ‘ I feel this is a very well run home in which my mother is well cared for and is very happy’. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. The recreational and social needs of service users are well catered for which enables service users to make daily choices and promotes independence. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Flexible visiting arrangements allow the residents to maintain good and regular contact with family and friends. Residents confirmed that they could have as many visitors as they like and at any time. People spoken to follow their own hobbies and participate in activities according to their wishes. One service user said they particularly enjoyed the trips organised by the home and thought the activities organiser did ‘a grand job’. A program of activities was displayed, it included such things as baking, card games, art and craft and bingo. Service users said the food was ‘really good’. One service user said ‘the food is really nice, the choice is smashing, I’ve put a few pounds on since I arrived’ Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. Service users can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirmed they were aware of these procedures. Knowledge of these ensures that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. Comment cards returned by service users and there representatives evidenced that if people were unhappy with the service they knew who to speak to and were confident that any concerns or complaints would be dealt with properly. Staff training has taken place in the protection of vulnerable adults in abuse. Staff recruitment procedures were adequate, ensuring staff were employed and deployed following appropriate CRB and POVA checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. The home was clean, comfortable and well-maintained providing service users with a safe and pleasant environment. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Some service users bedrooms and all the communal areas and bathrooms were inspected. These were all nice and clean and fresh. One service users said ‘ this place is always spotless, my room get cleaned everyday’. The bedrooms and communal areas were comfortably furnished, and all the dining rooms were bright and airy. One service users said ‘I love my room, I was allowed to bring in my favourite things from my own home.’ Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 15 Since the last inspection a conservatory has been built, the service users have decided on the décor, furniture and flooring. Several communal areas and service users bedrooms have been refurbished and redecorated. An existing bathroom has been converted into an assisted shower facility that is well used by service users. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. Service user can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was evidence of on going training for staff in such things as dementia care, moving and handling of service users, fire awareness and prevention of falls. The training offered to all staff was comprehensive and it was evident that the manager was committed to having a fully trained and competent staff group. From the rota supplied with the pre inspection questionnaire there was sufficient care staff on duty to meet the assessed needs of service users. Service users said that staff were always around and answered the call bells quickly. One service user said ‘the staff are always popping in to see if I am okay ’. Another service user said ‘they are always around checking to see if we are alright’. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 17 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): 31,33,35,38 Quality in this outcome area is good. Service users can be confident that the home is well managed. Systems and safeguards are in place to ensure the health, safety and welfare of service users and staff is protected. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There was an open, friendly culture between the management team and the staff at the home. Staff said they felt very well supported in their work. There was evidence is staff files that regular supervision of staff takes place and that staff are appraised. Service users said that the manager was approachable and would ‘always get things sorted out’. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 18 There are good systems in place to measure the quality of service that is provided at the home, and evidence was seen of action that had been taken following audits carried out at the home. The homes health and safety file was examined; all equipment in the home is regularly checked with valid certificates issued. There are no outstanding issues from environmental health inspections or the fire and rescue services. Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 19 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 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 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 Willowdene Care Home DS0000059169.V311744.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!