Inspection on 19/01/06 for Willowdene Nursing Home

This inspection was carried out on 19th January 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Willowdene Nursing Home 11/01/07

Willowdene Nursing Home 14/07/05

Willowdene Nursing Home 04/03/05

Willowdene Nursing Home 14/09/04

Willowdene Nursing Home 17/03/04

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

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

CARE HOMES FOR OLDER PEOPLE Willowdene Nursing Home Victoria Road West Hebburn Tyne And Wear NE31 1LR Lead Inspector Mrs Katie Tucker Unannounced Inspection 19th January 2006 08:15 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 Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 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 Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Willowdene Nursing Home Address Victoria Road West Hebburn Tyne And Wear NE31 1LR 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) 0191 483 7000 0191 483 7101 Premier Nursing Homes Limited Mr Patrick Joseph Morley Care Home 52 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (52), Mental disorder, excluding learning of places disability or dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (52) Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2 service users MD(E) also have a learning disability Date of last inspection 14th July 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 DS0000000277.V265715.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Willowdene inspection was carried out as part of the routine yearly programme. No one was told that the visit was to take place. An inspector visted and spent half a day at home. The inspector looked at the residents’ records, medication and staff information. The staff were asked about the residents’ records, the guidelines for dealing with complaints, their training, staffing levels and changes to working practices. The residents were asked about their lives at the home. Willowdene provides a service for people with memory loss. So some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well: The manager and deputy manager are very competent. They understand the needs of the service and care a great deal about the resident’s. And, they are very skilled at spotting gaps in the service and putting successful measures in place to improve practices. The manager and nurses keep abreast of new developments around looking after people with mental health care needs. Where new practices are appropriate for the service they help staff introduce them at the home. Staff work well with residents and clearly care a great deal about them. Staff chatted to residents and listened to people’s views. The staff valued resident’s wishes and people could choose want they wanted to do. There was lots of friendly banter going on through the day, which everybody enjoyed. The nurses work hard to motivate staff to develop their practices and provide a range of in-house training. Plus 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. The nurses are very aware of person centre approaches to care and have been able to care for people who have complex dementia care needs. Also staff always try to use various other strategies before using any type of sedative medication. This leads to residents being more alert and able to join more fully in completing everyday tasks. Relatives feel that staff were very kind and work hard to ensure their loved one is looked after. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 6 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. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 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 Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 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 and 6 The assessment tool does not allow staff to evidence that they can meet the needs of the service user but as with the other records this is being rectified. EVIDENCE: 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. The manager is making changes to the guide so it provides information to assist people make a decision about whether to move to Willowdene. The home’s contract complies with the standard and is available. Thus people are aware of their rights and what they will receive for their money. The majority of people have received terms and conditions and placing authority contracts and a copy is now kept at the home. As yet those people who privately fund their care do not have a copy stored at the home and should have. 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 Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 9 demonstrate their agreement to these house rules. In light of the Bournewood judgement this is extremely pertinent to this service. The assessment tool staff currently use is suitable for those people who are able to communicate fully and have general nursing needs. It does not give enough information about the care needs of people with dementia or mental health needs. The assessment 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 aimed at working to support people’s mental health needs and this tool does not show that staff complete any of this type of work. 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. Premier Nursing Care Limited is in the process of changing the assessment so it meets the needs of Willowdene. They have also encouraged staff at the home to assist them design a new assessment tool. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 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 and 9 The care records design prevents staff evidencing the good practices used at Willowdene. Medication practices are maintained to a good standard. EVIDENCE: Due to the limitations in the assessment document staff are not able to show they plan care around people’s greatest needs. Resident’s records must cover the social care, as well as health needs of all residents. And, the plans need to take into account information about each person’s social background and lifestyle. Residents or relatives need to sign all records to show they have agreed to the plan. Although risk assessments have been used in relation mobility. These tools for showing that the risks people take have been judged to be acceptable need to be more widely used. The style of writing staff have adopted leads to the information that is recorded being very informative. The owners and manager are aware that plans must reflect how people’s aims and goals are met. Thus new records are being developed. The medication on both floors was being accurately booked in and recorded when given to residents. Also it was being stored correctly. Staff were very knowledgeable about the types of medication being used at the home. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 11 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, 14 and 15 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 left and although this post has been advertised for sometime the vacancy remains. The manager has found that two care staff are very good at organising social events; sing a longs and other similar activities. And, he is looking at how to make the post more attractive. The owners should also consider how to attract people to this post. Again, it was noticeable that there were no books, games etc readily available. Residents’ were making some chooses about how they spent their time. But staff need to be mindful of the need to show that people can wherever possible follow a routine that suits their needs. If because of people’s health they are unable to make informed choices this needs to be recorded in their care plans. The catering budget and meals that are provided are nutritious. The manager and staff are aware of practices that will make sure people eat sufficient food. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 12 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 and 18 The manager follows the local authorities protection of vulnerable adults procedures. The manager listens to concerns and does what is needed to sort out any shortfalls. EVIDENCE: The relatives have said they are confident that the manager would deal with any concerns. The manager always deals with all concerns in a proactive manner. He has welcomed residents and relatives views. Where people have raised concerns he has dealt with these to the satisfaction of all concerned. And, makes sure the actions have been taken are continued. Relatives said that the staff and the manager were ‘friendly’, ‘helpful’ and ‘kind’. 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 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. South Tyneside provides training for staff in how to adhere to POVA requirements so far the manager and deputy manager have been and plans have been made for all of staff to receive this training. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 13 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 and 26 The home is well decorated the décor is starting to be changed so it assists 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 well maintained. 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 recently some environmental adaptations have started to be made to assist people with memory loss find their way around. The manager is very aware of small Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 14 environmental changes that could be made to make the environment more user friendly such as using different colour schemes in different areas. Throughout the day the temperature of the home, particularly on the first floor was in excess of 26°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. 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. At the last inspection it was required that air conditioning was provided but this is yet to be put in place. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 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 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): 28, 29 and 30 Staff training is now being provided at a level that will really enhance the service. Staff records have minor shortfalls in their format. EVIDENCE: The manager has been working hard to ensure that staff receive specific dementia care training, managing challenging behaviour, attend multi-sensory courses as well as mandatory training. Nearly 50 of the care staff now hold an NVQ level 2 and more five more staff have been enrolled on this qualification. A number of staff have completed level 3 awards and one staff members has started level 4 in care. Two of the nurses are NVQ Assessors and the manager holds this award as well as an internal verifiers award. The manager is hoping the home will be registered to accept student nurses. Staff are keen to train and practices have become more person centred. Throughout the visit staff worked well with people and really had a good understanding of people’s life history. Staff of ten matched their behaviour so it reflected people’s lived reality and this worked extremely well. Staff were very sensitive and caring. The resident’s said the ‘girls are great and really know what they are doing’. The staff files include the appropriate information. However in light of the changes to the regulations and introduction of the Disability Discrimination Act 1995 the application form and health statement need to be changed. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 16 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 and 38 Effective home management structures are in place to ensure the home operates well. One health and safety issue is 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 working toward the Registered Managers Award. Premier Care Nursing Limited has put in place a quality assurance tool and this is regularly reviewed. The company does not hold personal allowances, as relatives or the appointee deal with all issues related to finances. When money is needed the exact amount is requested from the appointee or relative. Other than the excessive heat no health and safety issues were noted. Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 17 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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 18 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 OP2 Regulation 5 Requirement All private funded service users must have copies of their statement of terms and conditions maintained at the home. The new assessments tools must be introduced All staff must receive local authority POVA training. The owners must continue to ensure that the internal design of the building meets the needs of people with a dementia. The owners must make sure the recruitment practice reflects the amendments and requirements of the regulations. Timescale for action 22/06/06 2. 3. 4. OP3 OP18 OP19 14 (2) 18 (1) (c) 23 (1) (a) 12/10/06 14/08/06 12/10/06 5. OP29 19 14/08/06 6. OP38 23 (2) (p) A full career history must be recorded on the application form. Air conditioning units must be 25/05/06 installed and industrial extractor fans provided in the laundry. (Required at the last inspection – timescale 20/10/05) Willowdene Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 19 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. Refer to Standard OP27 OP31 OP37 Good Practice Recommendations The company should continue to consider introducing a staff retention policy and career development initiatives. 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 DS0000000277.V265715.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Nursing Home DS0000000277.V265715.R01.S.doc Version 5.1 Page 21 - 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!