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Inspection on 14/01/09 for Willows Court
Also see our care home review for Willows Court for more information
This inspection was carried out on 14th January 2009.
CSCI found this care home to be providing an Poor service.
The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
What the care home does well
Willows Court is a residential care home situated in a residential area, close to shopping area. Some people have lived at the home for many years and are happy with their lifestyle, whereby, their needs are met and they are able to go out independently or with their family or friends. People are offered a good choice of meals, snacks and drinks throughout the day. Some staff work hard to provide quality care to enable to have a quality life at the home. The relatives we spoke with were happy with the care and support provided to their relative; felt the staff at the home were polite and kept them informed about their relatives well-being and any emergencies. They made the following comments: "Compared to the other homes, this isn`t bad" "The staff really worked hard and got him a special mattress" "We were told by the hospital he would never walk and to see him walking, talking and speaking his mind and eating everything on the plate, we know he`s alright" "We think the home`s been the right place for him, especially as we were told he`d never walk again".
What has improved since the last inspection?
Since the last inspection of the service, Willows Court has recruited a manager, who submitted an application to be the registered manager. The manager underwent an interview to assess her fitness to manage the home and is now the Registered Manager. Willows Court has also recruited an Activities Co-ordinator, who works three days a week, planning and doing a range of activities with people in small groups and individually. There is new dining room furniture, new dining chairs and tables for people. A new shower room is being made upstairs and the staff toilet is being tiled. We were told about the new bedroom furniture and furnishings that has been ordered and is due to be fitted from the 19th January 2009 onwards. This will include new carpets, curtains, beds, bedding and bedroom furniture. There has been some training provided to staff in relation to medication training and protection of vulnerable adults (pova).
What the care home could do better:
The information people receive about Willows Court is out of date and mis-represents what people can expect if they choose to use the service. Care planning and risk assessments lack detail and guidance for staff to provide the care and support safely, which respects people`s preferences and routines. Whilst staff have received training in health and safety, the lack of management and direct supervision places people at risk. There must be significant improvements made in the home, in relation to the home environment, individual bedrooms and bathrooms, lighting, equipment, security and hygiene practices to ensure people`s health, safety and well being. There is a lack of direct leadership and management of the home evident from the insufficient staffing levels and care practices, which effects the quality of care and support people receive.
Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.
Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Willows Court 107 Leicester Road Wigston Leicestershire LE18 1NS The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry
Date: 1 4 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 50 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 50 Information about the care home
Name of care home: Address: Willows Court 107 Leicester Road Wigston Leicestershire LE18 1NS 01162880223 01162880223 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BestCare Limited Name of registered manager (if applicable) Miss Rebecca Keightley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No one falling within category MD(E) or DE(E) may be admitted into Willows Court when there are 18 persons of category MD(E) or DE(E) already accommodated in the home No one falling within category OP may be admitted into Willows Court where there are 29 persons of category OP already accommodated within the home No one falling within category PD or PD(E) may be admitted into Willows Court when there are 24 persons of category PD or PD(E) already accommodated in the home No one under 55 years falling within category PD may be admitted into Willows Court Rooms 21, 22 and 23, within Willows Court are not to be used for residents who fall within categories PD or PD(E) Care Homes for Older People
Page 4 of 50 care home 29 Over 65 18 18 29 24 0 0 0 24 The maximum number of persons accommodated within Willows Court is 29 To be able to admit the named person of category PD named in variation application number V32221 dated 15th May 2006 Date of last inspection Brief description of the care home Willows Court is a residential care home for up to 29 people. The home is a modern property situated in a quiet residential area of Wigston town and is accessible by main road and bus services. Accommodation is over three levels with the majority of bedrooms being on the first and lower ground floors. All levels of the home are accessible by a passenger lift. There are two lounges and a dining area with a conservatory attached. Smoking is only permitted in the conservatory area. There are six shared rooms with en-suite facilities. Eric, the cat, lives at the home. The Registered Manager provided us with the range of fees charged: £334.00 to £425.00 per week, which excludes personal expenditure such as toiletries, newspapers, chiropody and hairdressing. People considering using Willows Court are encouraged to contact the home directly. The full details about the home and any specific requirements can be obtained from the home in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Commission for Social Care Inspection is available at the home. Care Homes for Older People Page 5 of 50 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We as it appears throughout the Inspection Report refers to The Commission for Social Care Inspection. This key inspection of Willows Court consisted of preparation by reviewing the last key inspection report dated 18th February 2008. We looked at the information we had about the management of Willows Court, the concerns and the complaints. We had received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document, which reflects the homes own assessment of the Care Homes for Older People
Page 6 of 50 standards within the home. We sent out nineteen surveys to the people living at the home and their relatives, of which none were returned. We sent out sixteen surveys to the staff, of which only two were returned. The comments and responses from the staff surveys are included in the relevant sections in this inspection report. We sent out surveys to four General Practitioner Surgeries, of which none were returned. We were planning to inspect the service earlier until we received information and concerns that people living at the home were not receiving the care and support they needed, cleanliness of the home, quality of food, staff training and the home environment. This information was managed as a safeguarding alert, which means that people are at risk or suspected to be at risk from abuse and/or neglect. We were further delayed in carrying out this inspection due to a lengthy outbreak of scabies within the home. We visited Willows Court on 14th January 2009, starting at 7.30am and finishing at 6.15pm. The Registered Manager and the Responsible Individual arrived later that morning and assisted us during the site visit. The main method of inspecting we used was case tracking. This means looking at the range of care and support needs people receive with consideration to their individual cultural and diversity needs. This was done by selecting five people, all having a range of different needs, levels of independence and lifestyle. We spoke with the people we identified to case track and other people living at the home. We looked at their care records that are also available to them and the staff that look after them. We also spoke with some visiting relatives. We made observations throughout the day of the staff and their conduct with the people living at the home. We looked at the living environment including some individual bedrooms. We spoke with the staff on duty, looked at the staff recruitment and training records and records that demonstrate the management of the home. As part of this key inspection, we looked issues of concerns raised in the safeguarding alert. Throughout the day, we shared our observations, findings and concerns with the Registered Manager and the Responsible Individual. The Commission for Social Care Inspection has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the care home does well: What has improved since the last inspection? Since the last inspection of the service, Willows Court has recruited a manager, who submitted an application to be the registered manager. The manager underwent an interview to assess her fitness to manage the home and is now the Registered Manager. Willows Court has also recruited an Activities Co-ordinator, who works three days a week, planning and doing a range of activities with people in small groups and individually. There is new dining room furniture, new dining chairs and tables for people. A new shower room is being made upstairs and the staff toilet is being tiled. We were told about the new bedroom furniture and furnishings that has been ordered and is due to be fitted from the 19th January 2009 onwards. This will include new carpets, curtains, beds, bedding and bedroom furniture. There has been some training provided to staff in relation to medication training and protection of vulnerable adults (pova). Care Homes for Older People Page 8 of 50 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 50 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 50 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive incorrect information about the home and only have a basic assessment of needs carried out, which may not meet individual needs. Evidence: We received a copy of the information people receive about the home known as the Service User Guide and the Statement of Purpose, from the Registered Manager. The information tells people the range of services offered at the home, including the support to meet care needs; social opportunities, the home environment, choice of meals and the skills mix of staff. The assessment and admission process for anyone considering using Willows Court is set out to help people to make sure the home would be right place for them. There was some information in both the Statement of Purpose and the Service User Guide, which was out of date and not reflective of Willows Court at the present time.
Care Homes for Older People Page 11 of 50 Evidence: For example, the document was last reviewed in January 2008, has the name of the previous Registered Manager, details her qualifications, skills and experience and makes reference to the National Care Standards Commission and not the Commission for Social Care Inspection. There was no evidence that the written information about the home is presented in a way that may help those who have difficulty in understanding information due to their health needs, such as Dementia or poor eyesight. This indicated that although the management team review the information, it is not updated regularly, nor have they acted upon the recommendation made at the last inspection. Therefore, people may be making decisions about using Willows Court, based on out of date information, which may affect their wellbeing if the home is not able to meet their needs. People using Willows Court, funded by Social Services are provided with an Individual Placement Agreement, which outlines the terms and conditions of stay. There was no evidence of a contract on the file where the person pays for their own care. The visiting relatives told us they visited the home at short notice to make sure it was the right place. The comments we received from the visiting relatives indicated that this home was the right place for their relative as they have had a better quality of life and made comments like: Compared to other homes, this isnt bad We were told by the hospital he would never walk and to see him walking, talking and speaking his mind and eating everything on the plate, we know hes alright The staff really worked hard and got him a special mattress We think the homes been the right place for him, especially as were were told hed never walk again We spoke with two people we case tracked and other people that were happy to talk to us. Some people could not remember when they moved to the home. Two people said the family found the home for them and they were quite happy. The information we received from the Registered Manager before the site visit stated the assessment of needs is comprehensive and captures all the requirements of the service user prior to admission. It also told us that there is a new needs assessment and care plan introduced. Care Homes for Older People Page 12 of 50 Evidence: We wanted to find out if the assessment process helped to identify peoples care needs. We read the care files for the five people that we chose to case track. We saw evidence of a comprehensive assessment of needs carried out by the Social Worker for people who were funded by Social Services. The homes current assessment of need format is basic and contains basic information about person and their care needs. There is little or no information about the individual preferences, dislikes or routines. The new needs assessment appears to allow staff to record information about all aspects of the person and their preference of lifestyle, if used correctly. However, we were unable to see the benefits of whether the homes new needs assessment format, as the home has voluntarily agreed not to admit any new people into the home, for a period of time. We wanted to find out who is responsible for doing the assessments and what information is passed to staff. We spoke with two staff on duty who told us the Registered Manager completes the assessment and they receive information about peoples care needs. This was consistent with the responses received in the staff surveys. We spoke with the Registered Manager to establish if she is trained to carry out assessment of needs and risk assessments. They told us that they had received training from the management consultant recruited by the home for a short period of time but has not yet identified any formal training. The Registered Manager must consider formal training whilst the home has agreed not to admit any new people into the home, to make sure she is confident and competent to assess peoples care needs and risk are managed. This would demonstrate that people who chose to live at Willows Court are confident that their needs will be met safely. Care Homes for Older People Page 13 of 50 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and health needs are not met safely by the staff, poor care planning and the care practices within the home that leaves people at risk. Evidence: The information we received from the Registered Manager before the site visit stated the needs assessment is very comprehensive; we have detailed care plan to capture the needs, preferences, daily routines, hobbies, interests, medical records and regular reviews and daily observations enables us to personalise the service for each service user. Although we sent surveys out to the people living at the home and their relatives, none were returned. We wanted to find out how the health and personal care needs of people living at the home were met and the practice in the home. We read the care plans and records for five people and observed the care and support they received during our visit. We saw people were already up and sitting in the lounge at the front of the home
Care Homes for Older People Page 14 of 50 Evidence: watching television, whilst others were sitting in the lower lounge and some were still in their bedrooms. People we spoke with told us they wake up at different times, some said they wake up at 4am, whilst others said they wake up at 6am and 7am. We observed a number of incidents and situations where we concluded there are not sufficient numbers of staff working in the mornings to meet the needs of the people. We shared the observations made from 7.30am with the Registered Manager and the Responsible Individual. After arriving at the home at 7.30am; waiting for the door to be answered and 10 minutes of looking for the person-in-charge, we found the senior carer for the night shift. Upon introducing ourselves, they said yes, Im the senior but I cant help you because I finish at 8am. She and another member of staff continued, what appeared to be, carrying out laundry duties and leaving the home unattended. We observed two staff trying to wake a lady up to assist her into a hoist. The staff were waking the lady up by shaking her by the shoulder. This conduct immediately stopped when the staff realised we were watching them and they changed their practice and started to stroke her to wake her up. Although the staff training records showed staff had received training in moving and handling, practice observed by us was not safe. The two staff showed lack of awareness around them, as another lady got up and walked past them using the zimmer frame. The lady continued to the bottom of the short flight of stairs and then started to climb the stairs, holding the grab rail with the right hand, zimmer frame in the left hand and leaning backward. We saw one gentleman in the lounge, not wanting to sit down when staff told him the dining room was not yet ready. The gentleman kept rubbing and pulling the wet part of his trousers away from his skin. Although, another member of staff assisted the gentleman a short while later, there is a risk of pressure sores developing if people remain seated or in bed in wet clothing. This incident highlighted that staff were not recognising they need to help the person. We saw a carer taking responsibility to feed a gentleman during breakfast. On three occasions we saw the carer bring a fork with the food to the gentlemans mouth and took it away to answer the front door twice, and to fetch something from the kitchen on the third occasion. This showed lack of focus on the part of the carer and demonstrated staffing levels are not meeting peoples needs in the mornings. We also saw good practice whereby the senior carer was seen feeding a lady, talking with her, encouraging her to eat and staying with her until she had had enough to eat. We saw in the shower room, near the office, and the bathroom on the lower ground
Care Homes for Older People Page 15 of 50 Evidence: floor, bottles of prescribed creams: Oilatum Emollient, belonging to three different people. These were left on the wash hand basin and on the window sills. We told the Registered Manager and showed her what we had found. She immediately asked the cleaner who was cleaning the bathroom to return the items to the individual peoples bedrooms. However, care staff clearly have a practice, whereby prescribed creams are kept in the shared bathrooms. We found combs, toiletries and bars of soaps around the bath and wash hand basin in the bathrooms and toilets, even though there were soap dispensers on the walls. The senior carer on duty told us that bars of soap are used as there is no liquid soap in the dispensers, as she demonstrated by trying the soap dispenser. This shows the practice in the home, places people at risk of cross infection, especially as there has been a reoccurring outbreak of scabies in the home recently. During the afternoon and early evening, there was a relaxed atmosphere. We saw that staff were able to respond to peoples requests, some people were resting in their bedrooms and others sat in the lounge watching television. This was very different to the observations we made in the morning and highlighted the issue of staffing levels and management of the home that does not always meet peoples assessed needs at different times, especially in the mornings. We wanted to know how staff find out about peoples care needs. Staff told us that the care plans are kept in the office in the care files with other records relating to the individual person. The senior carers told us they did not refer to the care plans as they know the people they look after. The carer on duty, told us it was his first day back from being off sick and at no time did we see him make time to update himself with the needs of the people living at the home with the exception of participating in brief handover meeting. This showed peoples care needs may not be met safely as staff do not take responsibility to make sure they know the care needs of people, especially after being off work for a few days. We received two surveys from staff and both indicated that they are given up to date information about the needs of people. However, the care plans we read were basic using tick boxes to indicate the persons level of ability. There were comments such as 1 carer , 2 carers or uses a zimmer frame, which appeared to be guidance for staff. The guidance for staff is inadequate and does not show peoples preferences and wishes in how they want to be supported. Therefore, this did not support the information the Registered Manager sent to us before the site visit. We read the risk assessments completed for the people we case tracked. These were basic and did not have information showing the risks posed to the individual. There
Care Homes for Older People Page 16 of 50 Evidence: was no evidence to demonstrate what safety measures were considered other than 2 carers to assist. There was no evidence of the person being involved in considering the safety measures or the benefits for the individual to maintain and promote their health, safety and well-being. Whilst the care plans were reflective of the brief detail in the risk assessment, there was no clear guidance for staff to follow to ensure individual care needs are met safely and that respects individual preferences. Our observations made during the site visit reflected the impact on the care people received, as staff had little information and guidance to follow from the risk assessments and care plans. We saw records to show a gentleman we case tracked was having lots of falls. There was evidence that the home had contacted the District Nurse and a wheelchair was ordered. The senior carer on duty told us that two additional wheelchairs have been ordered for people who need them. This showed there was some positive action being taken to make sure risks were being reduced for some people. The care files had information about the support to meet the health needs of the people living at the home, such as the visits made by the District Nurse and the General Practitioner (GP). We saw records of visits and treatments given to people when the District Nurse or the GP have visited. During the day, we saw staff encouraging a lady to give permission to contact the GP as a she was not feeling well. Although the lady agreed to see the GP, staff told us later that she fell in the bedroom, the paramedics were called and she was taken to hospital. The senior carer told us that they are responsible for contacting the health care professionals or the emergencies services. Staff told us they felt they had a good relationship with the GPs and the District Nurse Team. Staff told us they were supposed to receive some training from the District Nurse for pressure area care, which is still to be confirmed. Although we sent surveys to the GP surgeries and the District Nurse Team, none have been returned. We spoke with the Registered Manager regarding staff training in moving and handling, pressure area care and risk assessments. They told us although staff had been on moving and handling training, it was evident that some staff need to be retrained. They also told us they have still not identified pressure area care training for the herself and the staff, in light of concerns raised where people have or are at risk of developing pressure sores. We suggested the home considers speaking with the Tissue Viability Nurse and identifies training in pressure area care and risk assessments. We spoke with some people we case tracked and some visiting relatives. People told
Care Homes for Older People Page 17 of 50 Evidence: us they were happy with the care they received and did not express any concerns about this. Relatives spoke about their observations regarding the care their relative had received during the 12 months of them living at the home. They told us they visit weekly and had noticed significant improvements, from their relative being withdrawn and remaining in bed to walking, talking and eating independently. The comments received further demonstrated that the home provided the care to meet this persons needs, which improved the quality of life they had. These comments included: We were told by the hospital he would never walk and to see him walking, talking and speaking his mind and eating everything on the place, we know hes alright He couldnt walk, came home from the hospital with a pressure sore and went back into hospital The staff really worked hard and got him a special mattress They called us when the cathetar got stuck and he was taken into hospital We think the homes been the right place for him, especially as we were told hed never walk again Considering he doesnt like to talk with people, hes quite happy sitting with people in the lounge We saw the locked medication trolley outside the dining room and the medication records folder left on top of the trolley. There should be a better way of keeping the medication record folder safe. Liquid medication and eye drops are kept in the locked fridge in the office, which does not support a concern we received alleging medication is kept in the fridge with food. The senior carer told us she and the other senior carers are trained to give people their medication. This supported the staff training records seen, showing the senior carers had received training to give medication. The medication is prepared into blistered packs by the Pharmacy. The management of medication and the practice to give out and record medication taken, was good. However, the instructions received from the GP when medication has been stopped is written in the health visits and the daily reports, and sometimes written on the back of the medication records sheet. This is not consistent with good practice and should be reviewed. Care Homes for Older People Page 18 of 50 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities and opportunities offered within the home and in the community are not reflective of peoples interests and lifestyle. Fresh ingredients could be considered in the planning of meals. Evidence: We wanted to find out how people spend their day and how staff working at the home support people with their daily routines. We did this by reading the information we received from the Registered Manager before the site visit, which stated the home has recruited an Activity Co-ordinator. We also made observations during our visits, read the care plans and the records for five people. We saw people were sitting watching television or reading the newspaper in the lounge before breakfast was served. We saw some people preferring to sit in the lower lounge, whilst other people were still in their bedrooms relaxing or sleeping. The care plans read, had some information about peoples interests and hobbies. The assessment completed by the Activity Co-ordinator did not reflect the interests and hobbies that were sometimes written in the care plans. This showed peoples interests
Care Homes for Older People Page 19 of 50 Evidence: were not taken into account, where known when planning activities. We saw records kept for people detailing the activities they did individually or in small groups, ranging from catching a soft ball to singing. This showed some people did join in activities on offer. Relatives told us they had not visited the home when an activity was taking place although had heard about the activity and games played in the home. The senior carer told us they give duties to the staff, ranging from helping people with their personal care, helping in the dining room and laundry duty. Staff told us that they do feel stretched in the mornings when people are still waking up or need two staff to help them with their personal care needs. We asked one person what time breakfast is served and was told 8am. However, the wall clock outside the dining room was showing 10.35am when it actually was 7.45am. Although the wall clock was taken off the wall, immediately when we told the Registered Manager, it could have been there for some time and confused people more if were trying to maintain some level of independence. We saw some people made their way into the dining room whilst staff were seen helping other people into the dining room. We saw people sitting at the dining table for up to 45 minutes before breakfast was served, as staff were told to serve the meal when everyone was sitting in the dining room. This showed the meal times were not as flexible to suit peoples timing but rather the staff. We saw one person fetch cutlery for himself and another person to eat their breakfast with, whilst two other people sat trying to eat fried egg on toast with their fingers. We observed a carer standing over a gentleman to feed them. On three occasions the carer brought food up to the gentlemans mouth, only to put the fork down to answer the front door twice and to go to the kitchen on the third occasion. The gentleman, appeared to be more confused and just sat there looking out of the window. When we brought this to the attention of the Registered Manager and the Responsible Individual, they said they had not been aware of this. This demonstrated the practice and the conduct by some staff is not managed and does not ensure or promote peoples dignity, rights, and well-being. One person was seen returning from a short walk, whilst other people were seen talking with their visitors in the conservatory. People were seen moving around the home independently, whilst others used the support of a walking frame. People who continue to smoke are able to do so in the conservatory, which is also used by visitors for privacy. Although the staff told us they now keep the door closed to the conservatory to reduce the risk of the trip hazard, the risk remains. We noted that the conservatory remained cold and it was unclear whether there was heating as the door leading out into the garden was left open for long periods.
Care Homes for Older People Page 20 of 50 Evidence: Family and friends are encouraged to visit their relatives at the home. Three visitors told us they visit weekly and have found the home welcoming and the staff to be very helpful. The visitors and some people living at the home told us they have had new dining furniture, which gives the dining room a modern look. The visitors complimented the meals served by saying that their relative enjoys his meals. They also said they were sad to loose the pond and the ducks in the garden. We shared our observations with the Registered Manager and the Responsible Individual. We concluded that there were not enough staff working in the morning to meet peoples needs, staff showed little awareness and focus to making sure peoples independence was promoted and to support peoples daily routines. (Also refer to Health & Personal Care, Staffing and Management and Administration). We did send out surveys to the people living at the home and their relatives, however, none were returned. This made it difficult to fully established if peoples experience of the home and their expectations of lifestyle are met. We wanted to find out the quality and choice of meals served at the home. The care plans we read had little or no information about peoples preferences of meals, but did state if the person required diabetic meals and drinks. We spoke with the cook, who was preparing lunch, to find how they get to find out what people like to eat. They said they are told if a person has a special diet and do not have time to talk with the person directly about their preferences, which can affect peoples well-being and choice. We wanted to know what skills and training the cook has to make sure people have a healthy and nutritious meals. They told us they had completed an advance course in Nutrition, and have developed new menus that have been given to the Registered Manager but are not in use yet. They felt they were unable to put into practice the knowledge gained from attending the course on nutrition, which could improve the quality of food people were offered. Comments received included: I think its better for residents to have fresh food, and I knew that even before I went on the nutrition course The only fresh ingredient used today was potatoes, everything else was tinned or frozen Rarely get fresh food in Have requested to have more fresh fruit and vegetable and even developed a new
Care Homes for Older People Page 21 of 50 Evidence: menu plan but this isnt put in place The lunch being served was roast chicken or ham-in-mash with sweetcorn, green beans and mash or rice. The meal looked appetising, with individual portions of vegetables and gravy. This did not support the concerns raised with Social Services regarding the meals. Several people took their time eating their meals, which showed they were not hurried and promoted their independence. This was different to what we had observed in the morning during breakfast. Care Homes for Older People Page 22 of 50 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service do not have their complaints addressed quickly and some staff do not promote or protect peoples rights and well-being. Evidence: We wanted to find out if people were aware of how to make a complaint and what the process was. We did this by sending surveys out to the people living at the home and their relatives but none were returned. The information we received from the Registered Manager before the site visit stated the we have reviewed and significantly improved our complaints procedure and introduced a new complaints form. We spoke with the people living at the home during our visit and looked at the records within the home and comparing these with the information we had. A few people we spoke with that were able to tell us how they have been able to complain and said they told the staff and the manager what their concerns were. Three people we spoke with said they had complained to the manager about the six missing jumpers; missing shoes and on the day one person wanted to know if we could do anything to find out about his missing cup, which he had complained about four days ago. This indicated that people do complain but their complaints are not responded to or addressed quickly . We spoke with two staff, who said that they were confident to listen to concerns and
Care Homes for Older People Page 23 of 50 Evidence: would pass the concern onto the Registered Manager. This was consistent with the response we received in the staff surveys and included comments I would try to reassure them myself but if necessary I would arrange for them to see a senior carer/home manager herself. The information we received from the Registered Manager before the site visit stated the home had received 3 complaints. We asked to look at the information people received, the complaints procedure and the complaints log. The complaints procedure was well written and set out the process of how complaints are looked into and the length of time it can take. The new complaints form looked easier to complete although it was unclear how people are supported to express concerns, especially if they are unable to complete a form. The complaints procedures did suggest to people that they can contact the regulating authority but were given different contact details for the Commission for Social Care Inspection. The Registered Manager and the Responsible Individual said they had devised a new recording log for complaints. We looked at the complaints log kept. There were no entries of the 3 complaints stated in the information received from the Registered Manager before the site visit, detailing the nature of these complaints. There was no record of the complaints we were told about during our visit where people had reported the complaint to the manager. We therefore, asked the Registered Manager what were the nature of complaints. Although she was able to tell us the nature of the complaints, of which one related to missing items of clothing. This demonstrated that the home continues to fail in following the homes own complaints procedure; including not recording the complaints received and the actions taken to address the complaint. This was identified as an issue at the last inspection. We looked at the staff recruitment records for three staff on duty. All the files contained records to demonstrate staff were appointed and started work after satisfactory references were received. There were records to demonstrate checks were carried out on applicants to make sure they are suitable to work with vulnerable people, known as the Criminal Records Bureau (CRB) checks and the protection of vulnerable adults check (pova). The staff rota viewed was reflective of the staff working on the day. However, the regular use of agency staff and staffing levels at the busy times of the day, especially in the mornings and at meal times, must be reviewed. (Also see sections in Health & Personal Care, Staffing and Management & Administration). We have been advised of two safeguarding adults referrals since 18th February 2008. The investigation for the latest safeguarding adults investigation resulted from concerns raised by the district nurses relating to the home not meeting peoples
Care Homes for Older People Page 24 of 50 Evidence: personal and health care needs, staffing, home environment and the management of the home. The Registered Manager and the Responsible Individual continues work with Social Services and they have agreed not to admit any new people into the home until significant improvements are made at the home. As part of this key inspection, we have looked at the issues raised in the safeguarding adults referral and looked at how this affects the well being of people living at the home. The findings were shared with the Registered Manager and the Responsible Individual and are reflected within this inspection report. The information we received from the Registered Manager before the site visit stated staff re-trained in the safeguard of adults policy and procedure (POVA). The staff we spoke with knew about the types of abuse that could happen in a care home setting and the actions they would take to report abuse. Staff were aware of the homes policy on safeguarding adults and whistle blowing. The staff training matrix looked at showed staff had received training in protection of vulnerable adults in May 2008. However, the Registered Manager did tell us that an updated staff training matrix would be sent to us, which has still not been received. (Also refer to the section relating to Health & Personal Care; Staffing and Management and Administration). Care Homes for Older People Page 25 of 50 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to make sure the home environment is safe, comfortable, pleasant for people to live in, that meets their needs. Evidence: Since the last inspection of the service and following the concerns raised through the safeguarding alert and the recent outbreak of scabies, the home is undergoing a programme of cleaning and refurbishment. The new dining room furniture, gives a new modern look, whereby some people now enjoy eating their meals. The Registered Manager showed us the bedrooms identified at the last inspection to be very dark, which are a little lighter now, having had the trees cut back to the side of the building. Further work is needed to increase the amount of natural light in the bedrooms in this area of the home, for people to consider using these bedrooms. The Registered Manager told us all the bedrooms are being re-fitted with new beds, wardrobes, bedside cabinets, carpets and curtains. The new furniture and furnishing is due to arrive on 19th January 2009. The Registered Manager told us that whilst the refurbishment takes place, people who use the service should not have their safety, privacy or quality of care affected. The Registered Manager told us that people using the service and their relatives were asked about the colour schemes for their bedroom, which was supported by the visitors who told us they were told about the bedrooms
Care Homes for Older People Page 26 of 50 Evidence: being decorated and furnished. We wanted to see the home environment in which people lived, from the lounges, bathrooms to the individual bedrooms. The dining room had a fresh clean appearance with the new furniture, which was commented upon by some people living at the home and the visiting relatives. We saw most people were sitting in the lounge at the front of the home, a few were sitting or sleeping in arm chairs on the lower ground floor, whilst the other people were still in their bedrooms. We saw the new shower room on the first floor and the staff toilet had been tiled recently by the tiler who was working on the day. Although it was early in the morning when we arrived, the home was clean and tidy. There were no offensive smells, as alleged in the concerns raised through the safeguarding alert. We saw the sling for the hoist being used by the staff was new and showed it had been replaced following concerns raised by a visit from Social Services. We saw three wheelchairs, a commode and a pile of foot-plates in the corner of the bathroom on the lower ground floor. It was unclear as to why there were a pile of foot-plates in the bathroom as the wheelchairs all had their own foot-plates. We brought this to the attention of the Registered Manager, who had no explanation as to why these were left in the bathroom, which could cause a possible hazard to the people using the service and the staff. We wanted to find out from staff their knowledge and practice on hygiene. Staff told us they had received training in infection control and health and safety, which supported the staff training matrix. Staff said the recent outbreak of scabies meant there was increased cleaning in the home and were required to follow strict hygiene practices. Staff recognised how changes in practice can increase the risk of cross infection within the home. We saw liquid soap dispensers on the wall and found that these were empty. We saw bars of soap around the bath in the bathroom and around the wash hand basins. This indicated people were sharing the soap bars, increasing the risk of cross infection, especially having a lengthy period of an outbreak of scabies and staff telling us what they had learnt from the recent events. This showed that whilst staff recognised the affect of poor hygiene and infection control practices, the provisions and practice within the home does not prevent people from being at risk. The home must have adequate provision of hand washing and follow the guidance and practice in infection control procedures. Care Homes for Older People Page 27 of 50 Evidence: We wanted to find out how the home had managed and made safe the potential trip hazard between the dining room and the conservatory. The Registered Manager told us the door to the conservatory remains closed unless people want to use it , in which case staff would help. We observed this in practice throughout the day, which supported the Registered Manager. We were told that the conservatory is to be relocated and the size of the dining room to increase as soon as the building plans are confirmed. Although staff are following procedures to ensure people are not at risk from the trip hazard, it also indicates that people are not able to freely go into the conservatory without the assistance of staff, thus restricting people from using the conservatory, when they want. The bedrooms looked at were individual and curtains hung temporarily to make sure peoples privacy and dignity was respected. The bedrooms have mis-matched bedroom furniture although bedrooms are due to be refurbished week commencing 19th January 2009. The people living at the home and the visiting relatives that we spoke with said bed linen and clothing is being replaced. No other concerns were expressed to us. We will look at this again at the next inspection of the service, by which time the home would have completed the programme of refurbishment. We walked up the stairs to the rear of the home, with the stair lift. This was very dark and we found out that the stair lift was not working. Although there is only one person living in the bedroom on the first floor in this part of the home, there is a risk of falls or trips due to poor lighting in this area, especially as there is also a stair lift fitted. We wanted to look at other areas of the home on the first floor and went upstairs from the front of the home. We found a used comb left on the window sill, which remained there some hours later. This is unhygenic and could be picked up and used by another person using the service, which would place the person at risk of infection. We saw the window wide open in the corridor on the first floor, leading out onto a flat roof from early in the morning and remained open for some hours later. This could have given people access to climb out of the window and falling. We saw the bedroom windows to the rear of the home did not have window restrictors and could place people at risk from unwanted intruders into the home. When we showed these areas the Registered Manager, they told us that window restrictors were being fitted as part of the refurbishment programme. However, there were no risk assessments in place and people may have been at risk of climbing out of the windows and possibly falling, for some time. There has also been a risk posed to people from unwanted intruders coming into the home, which the Registered Manager and the Responsible Individual had not considered for some time. Five people living at the home told us they were happy with the laundry arrangements.
Care Homes for Older People Page 28 of 50 Evidence: However, one person told us that they had reported to the staff some missing items of clothing (6 jumpers), which have still not been found. The visitors told us that they had always found their relative wearing his own clothing and had not reported to them that their clothing was lost. (Also see sections on Complaints & Protection within this inspection report). The Registered Manager told us that they are in the process of recruiting another cleaner and a person responsible for the laundry. This demonstrated that there was some recognition that the home must improve the laundry arrangement by recruiting a additional staff. The Responsible Individual told us that he is at the home on a daily basis and does not complete the formal monthly visits known as the Regulation 26 visit. Therefore, inspite of the Responsible Individual being at the home, they have failed to identify and address the practices and environmental issues within the home, which significantly affects peoples health, safety and well being. (See Health & Personal Care, Staffing and Management & Administration). Care Homes for Older People Page 29 of 50 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels needs to improve to reflect peoples needs and requirements, and staff need to put into practice training that ensures people receive the care and support they require safely and timely. Evidence: We wanted to find out what whether the numbers of staff and their care skills are able to meet the needs of the people living at Willows Court. This was an issue of concern raised through the safeguarding alert. When we arrived at 7.30am we found it difficult to find the staff and the person in-charge. After 10 minutes, we met the senior carer who was in-charge, as described in section Health & Personal Care. We shared our observations with the Registered Manager and the Responsible Individual regarding the staffing at that time. We saw staff gather in the office at 8am for a handover, which lasted about 5 minutes, briefly talking about some people living at the home and the CSCI Inspector. We tried to establish the staffing numbers and noted the staff on duty consisting of 2 senior carers, carer, cook and the cleaner, totaling 5 staff. The Registered Manager and the Responsible Individual arrived later. However, the statement of purpose that we read states there is 6 staff throughout the day. Clearly this was not the case as the staff rota was reflective of the three staff on duty and included the carer returning from
Care Homes for Older People Page 30 of 50 Evidence: being off sick. We observed the morning to be rushed especially for breakfast, where staff were not able to respond to the needs of people. There were many examples observed, including the way one gentleman was helped with his breakfast, lack of awareness of people not having cutlery on the dining table and the staff not being aware of the people around them who placed themselves at risk of falling by climbing the short flight of stairs holding the grab rail with one hand and the zimmer frame in the other hand. We shared our observations with the Registered Manager and the Responsible Individual who were surprised. This reflected the conduct of the management at the home. The evidence clearly highlighted that staffing levels currently do not meet the needs of the people living at the home, safely and timely. In addition, we found out from the Registered Manager that the home continues to use agency staff and that the senior carer in charge when we arrived in the morning was a regular agency worker. This highlighted that agency staff are responsible for the home and the well-being of the people living at the home without regular monitoring and supervision. The relatives said the staff are polite and helpful and keep them informed about the wellbeing of their relative. We wanted to find out from the staff what roles and responsibilities they had and if the staffing levels met peoples needs safely. Staff said: Very rushed in the mornings and could do with another person on duty. I give them jobs to do but I end up having to do it. Better for staff and residents to have regular permanent staff who know the residents and routines of the home This further supported the issue of staffing levels and staff being unable to make sure peoples needs are being met, because too few staff are having to do everything. The staff survey responses indicated there were usually enough staff on duty, supporting what we observed and found during the visit. We wanted to find out how staff were recruited and whether the recruitment of staff promoted the health and well being of people who use the service. The staff spoke with and records viewed showed that staff recruitment procedures were satisfactory. We wanted to know what induction and training is completed by the staff. Staff told us that the induction training and training consisted of watching a video and answering
Care Homes for Older People Page 31 of 50 Evidence: multiple choice questions. Staff told us they had recently completed the moving and handling training, which was practical learning. The information we received from the Registered Manager before the site visit stated the home uses the Common Induction Standards and Skills for Care. However, this was not consistent with what staff had told us. The induction training records looked at in the staff files showed an in-house induction programme is used, which covers the homes policies and procedures. We discussed with the Registered Manager the need to provide induction training in line with current guidance and best practice and suggest they consider looking at the training organisations such as Skills for Care. The staff training matrix that we received showed staff had received training on a range of topics from March 2008 to August 2008. The training ranged from pova (protection of vulnerable adults), fire awareness, moving and handling, medication (senior cares), dementia awareness, challenging behaviour, infection control and healthy eating. Some staff have attained National Vocational Qualifications (NVQ) in care level 2 and above that represents 30 of the staff team. The Registered Manager told us the updated staff training matrix would be sent to us, but this has not yet been received. The observations we made during the site visit of care practices in relation to moving and handling and the health and safety practices used, showed a lack of awareness of risks to people in the home. The information received including the comments received showed there were inconsistencies in practice from what we were told. We shared this with the Registered Manager and the Responsible Individual. Whilst they were both surprised, it further demonstrated the staffing and the management of the home must be reviewed to make sure people have their needs met safely. (Also see the sections Health and Personal Care, Daily Life and Social Activities, Complaints and Protection and Environment, within this report). Care Homes for Older People Page 32 of 50 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home does not recognise, protect or promote peoples health, safety and well being. Evidence: The Registered Manager for Willows Court has attained (NVQ) 2 and 3 and is currently in the process of completing NVQ 4. Although Willows Court has a new Registered Manager, the information people receive about the home, known as the Service User Guide and the Statement of Purpose has the details for the previous Registered Manager. Therefore, people are not receiving up to date information about the staff and management of the service. We wanted to find out how the management of Willows Court affects the people using the service. We read the information we received from the Registered Manager before the site visit and compared this with the staff survey responses and the conversations
Care Homes for Older People Page 33 of 50 Evidence: had with the staff during the site visit. We concluded that staff are supported and meet with the manager, in some instances at short notice, to discuss work issues. Staff told us that they have specific roles, whereby the senior carer gives duties and responsibilities to individual care staff. However, from our observations and the staff rota, it was evident that the staffing levels do not allow staff to work effectively. Although staff showed they cared for the people living at the home, they appeared to be tired by lunch time, which affected their morale. This was evident from the following comments received from the staff: Very rushed in the mornings and could do with another person on duty. The Responsible Individual for the service told us they had used the services of a management consultant for a few months, who had trained the Registered Manager and introduced management systems. However, it was unclear what management systems had been introduced and how this benefited the management of the home. Three people living at the home were asked if they have the opportunity to learn about the changes within the home that would affect them, such as the Residents & Relatives meetings. Two people we spoke with said they had heard about meetings but are not interested in attending. The visiting relatives told us they had never been told about any Residents & Relatives meetings. We saw no notices displayed around the home to show if these meetings are taking place and no minutes of any Residents & Relatives meetings were made available to us to read. Therefore it is unclear if people are given the opportunity to be involved in the Residents & Relatives meetings. We wanted to know whether Willows Court has a quality assurance process, which enables people who live at the home; their relatives and other interested parties to comment on the service. The Registered Manager and the Responsible Individual told us surveys are sent out on an annual basis. They told us they plan to conduct a quality assurance survey at the end on January 2009 upon completion of the refurbishment of the home. We advised the Registered Manager and the Responsible Individual that a report should be produced and to include the findings and how the service intends to improve. This report should be made available to the people using the service, their relatives, other interested parties and a copy made available to the Commission for Social Care Inspection. We wanted to find out how the people are supported to manage their money. Of the three people we spoke with, two said their relatives managed their money and sorted it out in the office. One person told us he managed his own money, which was kept in
Care Homes for Older People Page 34 of 50 Evidence: the office. The relatives we spoke with told us that a member of the family who was nominated as the power of attorney manages the finances for their relative. We viewed the records of two people and the amount of money held in the office, was consistent with financial records. The staff told us they have regular supervision with the Registered Manager and have regular staff meetings. We read the minutes of the last staff meeting dated 12/12/08, which covered the topics on the new laundry person, cleaning and CSCI inspection. We saw the dates for the full staff meetings displayed in the office at 2 monthly intervals and senior carers meetings on a monthly basis. This showed there were planned dates and staff were made aware of these dates in advance. We discussed with the Registered Manager care practice issues observed during the site visit in relation to meeting peoples assessed needs and health and safety. This specifically relates to moving and handling, pressure area care and practices to prevent the risk of infection procedures. We also discussed with the Registered Manager the lack of quality and content of information in the risk assessments and care plans to meet peoples assessed needs. Whilst these issues were accepted by the Registered Manager and the Responsible Individual, action must be taken to ensure staff are trained and supervised to ensure care practices meets the needs of the people living at the home safely, and that promotes their health, safety, well-being, rights and dignity. We discussed with the Registered Manager the risks posed to people living at the home from the bedroom and corridor windows that open out fully. This could place people at risk if they climbed out of the window. There were no safety measures or assessments of risks carried out to demonstrate the health and safety measures being considered. Although the Registered Manager told us that window restrictors would be fitted as part of the refurbishment programme for the home, it was unclear how long this risk had been left unattended. This demonstrated the premises are not secure and leaves vulnerable people at risk. We saw notices for the fire alarm tests and people told us that the alarm is tested regularly. The information we received from the Registered Manager before the site visit was supported by the clear labelling of equipment being tested and serviced. This showed people living at the home are supported by gas, electrical and fire systems which are regularly maintained. The observations made during the site visit indicated that whilst staff try to provide good quality of care, the staffing levels and management direction does not consistently ensure peoples health and safety. We concluded from the site visit, the
Care Homes for Older People Page 35 of 50 Evidence: information received from the Registered Manager and issues raised in the safeguarding investigation that the overall management of the home does not consistently ensure the health, safety and the well-being of the people using the service. The Responsible Individual told us he does not conduct the formal monthly visits known as Regulation 26 visits or produce any reports to show how well the service is managed. They told us they stopped doing these formal visits and reports as they are at the home on a daily basis. In light of the significant issues highlighted from this visit to the service, the Responsible Individual must consider re-starting the monthly Regulation 26 visits and produced reports to assess the quality of the service people receive. Whilst the Responsible Individual and the Registered Manager were very surprised when we shared our observations made during the site visit, they stated they would review and address the issues highlighted. These include the staffing and staff conduct; care practices including health, safety and hygiene; the content and quality of the records about people and their care needs and areas identified in the home environment, which places people at risk. (See the sections for Health & Personal Care, Daily Life & Social Activities and Staffing). Although we did see some ongoing improvements being made with regards to the home environment, as the issues highlighted in the report demonstrates, the management and leadership of the service needs to continue to improve. Care Homes for Older People Page 36 of 50 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15(1) Care plans need to be 18/06/2008 comprehensive reflecting all aspects of care, including specialist care such as Dementia, and provide information as to how the person wishes their care to be carried out and to include their preferred daily routines. Care plans to be supported by risk assessments, which are regularly viewed with the involvement of all relevant parties. The Registered Person to 18/03/2008 undertake a risk assessment of the potential trip hazard created when the doors are open between the dining room and conservatory, and to take steps to ensure the health and safety of people using the service. The Registered Person to 18/06/2008 ensure that there is sufficient natural light in the bedrooms to the rear of the property to ensure the safety and well being of people using the service. The Registered Person to ensure that care staff 18/06/2008 2 19 13(4) (c) 3 25 23(2)(p) 4 30 18(1) (c) Care Homes for Older People Page 37 of 50 receiving training relevant to their role, and should include moving and handling. Care Homes for Older People Page 38 of 50 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 1 4 The statement of purpose and service user guide must be kept up to date, contain accurate information about the home, services offered, staffing, training and the management of the home. To ensure people can make an informed decision about using the home that meets their needs. By failing to do so, you are in breach of Regulation 4 and Schedule 1, which is an offence under the Care Homes Regulations 2001. 21/02/2009 2 3 14 The person responsible for 21/03/2009 assessing the needs of people considering using the home, must by suitably qualified or suitably trained to ensure the assessment process is robust. To ensure the individual care needs are identified and can Care Homes for Older People Page 39 of 50 be met safely. By failing to do so you are in breach of Regulation 14(1), which is an offence under the Care Homes Regulations 2001. 3 4 13 The registered person must ensure that staff members perform moving and handling tasks safely. To ensure the health, safety and well-being of people. By failing to do so you are in breach of Regulation 13, which is an offence under the Care Homes Regulations 2001. 4 7 15 Care plans must be comprehensive reflecting all aspects of care, including safety measures identified from the risk assessments, clear guidance for staff and provides information as to how the person wishes their care to be carried out and include their preferred daily routines. This would ensure care needs can be met safely, risks minimised and staff promote peoples health, safety and wellbeing. By failing to do so you are in breach of Regulations 15 (1), which is an offence under the Care Homes Regulations 2001. 21/03/2009 21/02/2009 Care Homes for Older People Page 40 of 50 5 8 13 Regulation 13(3). Suitable 28/02/2009 provision of hand washing facilities must be provided to prevent the risk of cross infection and the spread of infection by elimating the use of bars of soap and follow the best hygiene practices. This would ensure people are not at risk of cross infection or the spread of infection that promotes their health and well being. By failing to do so you are in breach of Regulation 13(3) of the Care Homes Regulations 2001. 6 8 13 Regulation 12 and 13. Staff 21/03/2009 must receive training to meet peoples assessed needs. This includes pressure area care to be able to monitor, identify and take action to prevent pressure sores developing. This would ensure people are not at risk of developing pressure sores and promote their health, safety and wellbeing. By failing to do so you are in breach of Regulation 12 and 13 of the Care Homes Regulations 2001. 7 8 13 Regulation 12, 13(5) and 21/03/2009 18. Care staff must receive training to meet peoples assessed need. This includes Care Homes for Older People Page 41 of 50 moving and handling and be supervised to ensure the health and safety of people. This would ensure peoples health and safety is maintained. By failing to do so you are in breach of Regulation 12, 13(5) and 18 of the Care Homes Regulations 2001. 8 9 13 Regulation 13(2). Prescribed 21/03/2009 creams and oils used by the people living at the home must be kept securely and not left in the communal bathrooms to avoid risks to other people. This would ensure people are not at risk of using other peoples prescribed creams and oils to ensure their health, safety and wellbeing. By failing to do so you are in breach of Regulation 13 (2) of the Care Homes Regulations 2001. 9 12 16 Regulation 16(2)(n). To make sure people are consulted about their social interests and activities to be arranged by the home and put into place a range of these for people. This would ensure people have the opportunity to participate in activities of interest to them that promotes their well being. 21/03/2009 Care Homes for Older People Page 42 of 50 By failing to do so you are in breach of Regulation 16(2)(n) of the Care Homes Regulations 2001 10 15 16 Regulation 16(2)(i). Staff 21/02/2009 assisting people in eating meals must do so in a manner that is discreet, sensitvely, responsive to the individual who may take time, that promotes their health and well being. This would ensure people are not interrupted at meal times by staff being responsive. By failing to do so you are in breach of Regulation 16(2)(n) of the Care Homes Regulations. 11 15 16 Regulation 16(2)(g). 21/02/2009 Sufficient supply of cutlery should be provided to people at meals times that promotes peoples independence, well being and dignity. This would ensure people are able to eat their meals with dignity and promotes their independence and well being. By failing to do so you are in breach of Regulations 16(2)(g), of the Care Homes Regulations 2001. 12 16 17 Regulation 17 (2) Schedule 4(11). A record must be 21/02/2009 Care Homes for Older People Page 43 of 50 maintained of all the complaints made by the people living at the home or their representatives, detailing the nature and the actions taken by the registered person in respect of any such complaint. This would ensure complaints made can be audited and measured against the homes complaints procedures to ensure peoples safety, well being and rights are respected. By failing to do so you are in breach of Regulation 17(2) Schedule 4(11) of the Care Homes Regulations. 13 19 13 Regulation 13(4)(c) and 23(2)(o)(p). Have adequate heating to enable people to use the conservatory without restrictions. This would ensure the people well being is promoted by being able to use the conservatory at anytime. By failing to do so you are in breach of Regulation 23(2)(o)(p) of the Care Homes Regulations 2001 14 19 13 Regulation 13 (4). To remove from the communal bathroom the old or unused wheelchair foot-plates to 21/02/2009 21/03/2009 Care Homes for Older People Page 44 of 50 ensure peoples health, safety and well being. This would ensure peoples are not at risk of hazards. By failing to do so you are in breach of Regulation 13(4) of the Care Homes Regulations 2001. 15 19 13 Regulation 13(4)(c) and 21/03/2009 23(2)(o)(p). The entrance to the conservatory from the dining room must be made safe to avoid the risk of trips or hazards and without restricting when people can use the conservatory. This would ensure the people well being is promoted by being able to use the conservatory at anytime. By failing to do so you are in breach of Regulation 23(2)(o)(p) of the Care Homes Regulations 2001. 16 25 23 Regulation 23(2)(p). The bedrooms at the rear of the property must have sufficient natural light to ensure the well being of the people using the service. This would ensure people have sufficient lighting in the bedroom that meets their needs. By failing to do so you are in breach of Regulation 21/04/2009 Care Homes for Older People Page 45 of 50 23(2)(p) of the Care Homes Regulations 2001. 17 25 23 Regulation 23(2)(p). The stair case with the stair lift at the rear of the property have sufficient lighting to ensure the well being of the people using the service. This would ensure people using the stair case are able to see clearly, which promotes their independence. By failing to do so you are in breach of Regulation 23(2)(p) of the Care Homes Regulations 2001. 18 26 13 Regulation 13 (3). To 21/02/2009 remove personal prescribed creams and toiletries and bars of soap and ensure supply of hand washing products are available in the soap dispensers to prevent the risk of cross infection and promotes peoples health and safety. This would ensure people are not at risk of cross infection and practice is in line with the best practice for infection control procedures. By failing to do so you are in breach of Regulation 13(3) of the Care Homes Regulations 2001. 19 27 18 Regulation 18(1)(2). The staffing levels must be 21/02/2009 21/03/2009 Care Homes for Older People Page 46 of 50 sufficient to meet the assessed needs of the people living at the home and reviewed regularly to ensure staffing levels continue to meet peoples needs. This would ensure peoples health, safety and well being is promoted and maintained. By failing to do so you are in breach of Regulation 18(1) of the Care Homes Regulations 2001 20 30 18 Regulation 18, 13(5) and 12. Staff must be trained to care for the people living at the home. This includes moving and handling and pressure area care and be supervised to ensure the health and safety of people. This would ensure peoples health and safety is maintained. By failing to do so you are in breach of Regulation 18, 13(5) and 12 of the Care Homes Regulations 2001. 21 31 26 Regulation 26. The 21/02/2009 Registered Person must conduct the monthly visits and produce a report detailing the findings and the action plan to address issues and shortfalls with timescales to ensure the health, safety and well being of people. 21/03/2009 Care Homes for Older People Page 47 of 50 This would ensure the home is managed and the needs of people are met. By failing to do so you are in breach of Regulation 26 of the Care Homes Regulations 2001. 22 38 13 Regulation 13 and 23. The 21/03/2009 windows in the home must ensure the safety of people from the risk of falling out of and preventing unwanted intruders coming into the home. This would ensure up to date information is available ensure peoples needs are met safely. By failing to do so you are in breach of Regulation 13 and 23 of the Care Homes Regulations 2001. 23 38 17 Regulation 17. Records specified in Regulation 17, Schedule 4 and 7, must be detailed, well maintained, kept up to date and reviewed. This would ensure peoples choices are respected, whilst their health and safety is not compromised. By failing to do so you are in breach of Regulations 17 of the Care Homes Regulations 2001 21/03/2009 Care Homes for Older People Page 48 of 50 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 1 To review the accessibility of information about the home provided to people with consideration given to the needs of people living at the home. To ensure people have a contract detailing the terms and conditions of stay, where people are privately funding their stay. The recording of instructions from health care professionals regarding changes in medication should be consistently recorded to ensure up to date information is maintained and communicated with staff. Advice should be sought from the Pharmacist to ensure the storage of controlled drugs comply with the Misuse of Drugs (Safe Custody) (Amendment) Regulation 2007 to help prevent misuse or theft. Staff members should be vigilant to ensure peoples dignity is maintained by responding quickly to make sure people are clean and wearing dry clothing. To consider providing more fresh ingredients such as fresh seasonal vegetables and fruit as part of the nutritional diet for people. To ensure the decor and furnishing of the home and individual bedrooms take into account preferences and best practice guidance from organisations who advise as to how the decorating and furnishing can impact and improve the quality of life for people with dementia. The home should increase the numbers of staff that have attained or are in the process of attaining National Vocational Qualification level 2 in care to meet the needs of the people using the service. It is recommended that the homes induction programme is reviewed and updated, considering the Skills for Care training, which promotes the current best practice to ensure staff have the right basic skills and training to support the people living at the home. 2 2 3 9 4 9 5 10 6 15 7 24 8 28 9 29 Care Homes for Older People Page 49 of 50 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 50 of 50 - 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!