CARE HOMES FOR OLDER PEOPLE
Willowdene Nursing Home Victoria Road West Hebburn Tyne and Wear NE31 1LR Lead Inspector
Katie Tucker Unannounced Thursday, 14 July 2005 at 1.00pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Willowdene Nursing Home Address Victoria Road West Hebburn Tyne and Wear NE31 1LR 0191 483 7000 0191 483 7101 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Premier Nursing Homes Limited Mr Patrick Joseph Morley Care Home with Nursing 52 Category(ies) of MD(E) Mental disorder over 65 (52) registration, with number DE(E) Dementia over 65 (52) of places MD Mental disorder (5) DE Dementia (5) Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: (1) 2 service users MD(E) also have a learning disability Date of last inspection 04 March 2005 Brief Description of the Service: Willowdene is a purpose-built home providing nursing and residential care for 52 older people that may have dementia-type illnesses or mental health needs. Within this total number, two people admitted may have a learning disability and five people are under the age of sixty-five and have mental health needs. Accommodation is on two levels served by a passenger lift and stairs, each with self-contained facilities including lounges, dining areas, bathrooms and WCs. Both internally and externally, the property is accessible for wheelchair users. All bedrooms have en-suite WCs. Off road car parking is available at the front of the home and there is an enclosed garden at the rear, which residents may enjoy in good weather. The property is situated just off the main road running through Hebburn, and is within walking distance of a range of local amenities, including a health centre, pharmacy, library, a shopping centre, places of worship and public houses. The area is well served by public transport and the Metro station is approximately half a mile away. Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Willowdene Nursing Home, which was conducted as part of the routine yearly programme. An inspector spent half a day at the home and spoke to 18 service users and 4 visiting relatives. A sample of assessments and POVA procedures were examined. The staff were asked about the service user plans, access to training and any changes to working practices, as were the service users. The general maintenance of the building was checked. Willowdene provides a service for people with a dementia-type illness (memory loss) as well as for people with mental health needs. Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made on how well the approaches that were used were working. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. During this inspection key standards were focused on but not all were checked. What the service does well:
Since taking over the operation of the home the manager has greatly assist staff improve the range of skills and techniques they use to promote residents sense of well-being. The manager and nurses consistently review practices to ensure they are recognised as current good practice. The manager is extremely competent at identifying shortfalls in the service and putting measures in place to rectify these issues. The nurses work hard to motivate staff to develop their practices and provide a range of in-house training. Premier Nursing Homes Ltd are providing opportunities for staff to complete NVQ training and some of the staff have completed Level 3 in care and looking at starting a Level 4 course in care. Staff are very caring and considerate. They try to encourage people to join in conversations and make their needs known. The nurses are very aware of person centre approaches to care and help staff ensure that the care is offered in an individual way to residents. The staff have been able to meet the needs of people who have complex needs related to dementia care. Also staff always try to use various other strategies before using any type of sedative medication. This leads to residents being more alert
Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 6 and able to join planning their care. The relatives felt that staff were very kind and worked hard to ensure their loved one was looked after. What has improved since the last inspection? 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.
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Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 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 standard(s) 1,2 and 3 For all the documents are available these have various shortfalls, some minor and some major and this leads to these standards not being met. Service users and staff are not being given the full information about the home. The assessment tool does not allow staff to evidence that they can meet the needs of the service user or provide all of the information that would be needed to care for individuals. EVIDENCE: Premier Nursing Homes Ltd uses an assessment form, which is based on the Roper Tierney and Logan nursing model. The assessment tool seen has a small space to cover issues relating to mental health but the limited space does not allow staff to fully record challenging behaviours, triggers and actions that can be taken to divert or reduce such challenging behaviour. The majority of care practices will be directed at working to support people’s dementia care needs and this tool does not show that staff complete any of this type of work. Therefore the tool does not allow staff to demonstrate that they could meet the needs of the people who wish to use Willowdene Nursing Home. Also it does not assist the staff to evidence any decisions made about staffing requirements
Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 9 at the home. The owners stated that they have an appropriate tool, this has not been seen so will be looked at during the next inspection. A large number of people have a dementia-type illness and the generation of life histories for these people must be treated as a priority. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Staff collectively had a good range of knowledge about triggers for behaviour, people’s preferences and how to reduce people’s anxiety. The staff spoke in a relaxed and sensitive manner towards service users. Staff can describe the needs individual’s have and how to meet these needs. Service users and relatives were very complimentary about how staff worked and their caring and considerate nature. People said ‘the staff are excellent’ and ‘the staff are always kind and helpful’. The statement of purpose and service user guide produced by Premier Nursing Homes Ltd provides a summary of Schedule 1 of the Care Home Regulations 2001. However the guide is a generic and does not give specific information about Willowdene. Also the most recent inspection report is not issued to all of the service users. Thus much of the information, which would assist individuals to make a decision about whether to move to Willowdene is not available. The Regional Manager has produced a home’s statement of terms and conditions (contract), which complies with the standard and is included in the Service User Guide. Thus people will be aware of their rights and what they will receive for their money. However all of the residents have not been issued with new copies and so remain unaware of what they are entitled too. Where some people have received terms and conditions and placing authority contracts these are maintained at the head office and a copy is sent to relatives. In order to comply with the Care Home Regulations 2001 copies of both documents need to be kept in each person’s service user guide or service user plan so residents or their relatives can see them. The inspector discussed with the manager what a standard contract consists have and this helped to clarify what the difference is between the two types of contracts. Where house rules are applied to all service users such as needing to complete a risk assessment prior to decisions being made as to whether people could access the community independently this would form the standard contract. As with any contract the service users or their representative would sign to demonstrate their agreement to these house rules. In light of the Bournewood judgement this is extremely pertinent to this service.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8 and 10 The resident’s healthcare needs are being met. Staff work with people in a sensitive and discreet manner. EVIDENCE: The staff closely monitor residents well-being and when necessary ensure people have access to their local GP. The manager has forged links with the local PCT and is able to access further support for residents when this is needed. Staff demonstrated the ability to respond to people’s dietary needs and monitor people’s nutritional health. Previously dieticians have provided support. One of the residents was reluctant to eat and staff readily discussed the person’s usual pattern and how they were going to monitor this person diet and continue to encourage them to have a good calorific intake. Staff also discussed a range of strategies they would use to work with people when they were frustrated and how they would try to establish any underlying cause for this type of behaviour. This type of good practice reduces the level of potential challenge people may present and will lead a better quality of life for the people using the service. Throughout the day, staff worked with people in a sensitive and discreet manner. All intimate personal care tasks were carried out in a manner that would maintain people’s dignity.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13 There are shortfalls in the level of activity provided but the recruitment of an activities co-ordinator will assist to improve this area of care. EVIDENCE: It was quiet in all of the units during most of this visit. Staff stated that there were no specific activities being organised at this time. Residents were engaged in activities, such as chatting to visitors, listening to music and watching TV. The activities co-ordinator has recently left and this post is being advertised. Although care staff do chat with residents and engage people in activities such as dancing they do not feel confident about organising other types of events. At present they do not feel this is a role that they could undertake. The manager has found that one of the care staff is very good at organising social events; sing a longs and other similar activities. However it was noticeable that there were no books, games etc readily available and although one person loved to read they did not have access to any books. The relatives said that this care staff member was extremely good and wished there were more staff that would provide a range of activities. They felt that this was an area that had been developing but still there were long periods of time when people were unoccupied. Relatives discussed how welcoming and helpful staff were and that they were able to visit when they wanted and take their relative out for the day.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Although the policies outline how to protect individuals from abuse all the staff have not yet received appropriate training on how to safeguard people and this is a shortfall. EVIDENCE: Willowdene has a policy in relation to protecting vulnerable adults from abuse, this is a generic policy for all of the homes but does outline when the police would need to be called. Premier Nursing Homes Ltd has agreed to adhere to the Protection of Vulnerable Adults Procedures (POVA) developed by South Tyneside Social Services Department. The manager is in the process of completing the section of the local authority’s procedures so Willowdene’s policy links with these procedures. The manager is very aware of the actions that need to be taken to ensure people are safeguarded and when needed has carried them out appropriately. Although South Tyneside has provided training for staff in how to adhere to POVA requirements none of staff had be able to receive this training. POVA training is considered a mandatory requirement and therefore staff must be given access to the ‘alerter’ and where appropriate the ‘responsible individual’ courses. Since the last inspection the manager has been on ‘alerter’ training and Premier Nursing Homes Ltd expect him to cascade the training. The training is designed to enable people identify and act upon allegations of abuse and takes a day to complete therefore cascading this training will not allow for all of the information to be shared or staff to have such in depth training. The manager was made aware that at times the local authority will provide this training at a specific home and he has undertook to see if it can be offered at Willowdene.
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The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Although the home is well decorated the décor does not assist people with a dementia to find their way around. The ambient temperature of the home is excessive and not conducive to maintaining people’s well-being. EVIDENCE: Willowdene is located within a residential area of Hebburn. It is a purpose built property, with accommodation provided over two levels. A shaft lift allows access between floors. The home is decorated and furnished to a good standard and on the whole is kept well maintained, although the décor on the first floor requires refreshing. Externally there is a garden, which is accessible to all residents. The manager is planning to develop a sensory garden and has recently purchased a range of garden furniture. Willowdene has been specifically set up to provide dementia care but environmental adaptations that assist people with memory loss have not been put in place. The manager is very aware of small environmental changes that
Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 14 could be made to make the environment more user friendly such as using different colour schemes in different areas but is unable to make these types of changes. A number of publications outline how to make units less confusing and stressful for people with dementia-type illnesses. Also the J Rowntree Foundation and Stirling University provide information and guidance about environments plus how poorly planned living areas created challenging behaviour. In order to meet the requirements of the Disability Discrimination Act 1995 reasonable adjustments have to be made to accommodate the needs of people with a disability and this includes dementiatype illnesses. Willowdene under the Care Home Regulations 2001 must be fit for it’s purpose thus when re-decorating using techniques advised in the vast body of research on how to make the environment service user friendly for people with a dementia would ensure it met that requirement. Throughout the day the temperature of the home, particularly on the first floor was in excess of 30°c and the recognised safe and suitable temperature is 21°c. This excessive heat leads to residents dehydrating quickly, higher levels of frustration and general lack of energy. Also a lot of dressing packs have to be stored below 25°c otherwise it starts to degrade. Also the temperatures in the laundry were even higher and this leads to poor working conditions and the potential for the linen coming from the dryer not to cool sufficiently to prevent a build up of heat. It is well known in the laundry trade that the lint on linen can be a source of combustion in dryer or following a drying cycle. Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The staffing levels are flexible and at present meet the needs of the residents. Staff continue to complete specific training around meeting the needs of people with a dementia. EVIDENCE: At the time of the inspection there was two qualified nurses and 4 care staff upstairs and 1 qualified nurse and 4 care staff downstairs. An additional care staff member is to be provided full-time to meet the needs of one person when they return to the unit. Willowdene looks after a number of people with complex needs and who at times are very distressed. Some of these people have only recently moved to the home and the manager was in the process of determining whether they needed an additional level of support other than that the home normally provides. He was aware that should this be the case he could request that specific contracts were put in place and additional staff employed. At an inspection in 2004 it was identified that the lack of staff training had led to staff working inappropriately. This manager has been working hard to ensure that staff receive specific dementia care training, managing challenging behaviour, as well as mandatory training. 45 of the care staff now hold an NVQ level 2 and more staff have been enrolled on this qualification. Two staff members discussed how they were considering starting level 4 in care but were reluctant because of the lack of career progression offered in the home. Staff are keen to train and practices have become more person centred.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 Effective home management structures are in place to ensure the home operates well. Health and safety issues were compromising some practices. EVIDENCE: The manager has strong leadership skills and a track record of ensuring good services are ran. He recently successfully completed the final part of the process to become the registered manager for Willowdene. He is part way through the Registered Managers Award and finding a very useful course. Premier Nursing Homes Ltd use generic policies and procedures across all their homes and at times these do not reflect the actual practices that would be expected in Willowdene. Thus they can lead staff to take inappropriate actions or not act when the manager would expect them too. The company is reviewing the policies and the manager has undertaken to assist in this process. Other than the excessive heat no health and safety issues were noted.
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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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x x x x x x 2 Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 (1) Requirement A copy of the most recent inspection report must be included in the service user guides.(required at the previous inspection - timescale 10.06.05) The service user guide must reflect the actual service being offered at Willowdene. All service users must be issued with a statement of terms and conditions with the home and copies must be maintained at the home. (required at the last inspection - timescale 10.06.05) Staff at the home must be allowed to produce suitable assessments tools, which provide the appropriate information for the care of people with a mental health need and/or dementiatype illness.(required at the last inspection - timescale 1.09.05) The owners must ensure that the internal design of the building meets the needs of people with a dementia. All staff must receive local authority POVA training. All care staff who have not
Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 19 Timescale for action 15.12.05 2. 2 5 20.10.05 3. 3 14 (2) 12.01.06 4. 19 23 (1) (a) 12.01.06 5. 30 18 (1) (c) 15.12.05 6. 38 23 (2) (p) already done so must receive training on providing care for people with a dementia-typeillness. Air conditioning units must be installed and industrial extractor fans provided in the laundry. 20.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 27 28 31 37 Good Practice Recommendations The company should consider introducing a staff retention policy and career development intiiatives. A minimum ratio of 50 of care staff qualified to NVQ Level II or equivalent should be achieved by 2005. (Recommended at previous inspections.) The Manager of this home should have a relevant management qualification by year 2005. (Recommended at previous inspections.) The manager should review policies and procedures to ensure they reflect practices at the home and amend them where necessary. Willowdene Nursing Home B52-B02 S277 Willowdene V219815 140705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Baltic House Port of Tyne Tyne Dock South Shields National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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