Inspection on 24/06/09 for Willows Court

This inspection was carried out on 24th June 2009.

CQC found this care home to be providing an Adequate 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willows Court 07/01/10

Willows Court 14/01/09

Willows Court 18/02/08

Willows Court 09/05/07

Willows Court 18/05/06

Willows Court 07/11/05

Willows Court 08/08/05

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

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:   one star adequate 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: Linda Clarke     Date: 2 4 0 6 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 34 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 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): Name of registered manager (if applicable) Miss Rebecca Keightley Type of registration: Number of places registered: BestCare Limited care home 29 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 Care Homes for Older People Page 4 of 34 Over 65 18 18 29 24 0 0 0 24 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) 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. Information regarding fees is available by contacting The Registered Manager, for people who have their care funded by Social Services a representative of Social Services will undertake a financial assessment to determine an indivdiuals financial contribution to their care. 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. 1 4 0 1 2 0 0 9 The latest Inspection Report from the Commission for Social Care Inspection is available at the home. Care Homes for Older People Page 5 of 34 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: one star adequate 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: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by the Registered Manager, reviewing previous inspection reports, and any other information we have received. The unannounced site visit took place on the 24th June 2009, and took place between 08:30 and 16:00. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Willows Court. Three people accessing services were chosen and discussions and Care Homes for Older People Page 6 of 34 observations were held with them. We also spoke to other people who live at the home and visitors who were their when we visited. Staff members were spoken with along with the Registered Manager and one of the owners of the home. We also followed upon requirements made at the previous key inspection. What the care home does well: What has improved since the last inspection? What they could do better: Information provided to people who are considering or are already living at Willows Court needs to be updated, as the current information is out of date and in part inaccurate. Care plans need to be further developed to reflect the individual care and support people with dementia require, including what activities and events promote their wellbeing and enjoyment. The preferred daily routines of people need to be identified and recorded so that individual needs and preferences can be catered for, which is of particular relevance to those who cannot express themselves well. Care Homes for Older People Page 8 of 34 Improvements could be made to encourage the independence and enjoyment of people at mealtimes, by enabling people to serve themselves and by having a greater opportunity to comment and influence the menu and range of meals available to them. Environmental improvements need to be made to bedrooms which are located on the lower ground floor to the rear of the building, as they have very limited natural light which could be a health and safety risk to people who occupy the rooms as well as impacting on the quality of their daily lives. The Registered Person needs to consult with appropriate professionals to look at removing the trees which are planted close to these bedrooms as the trees are believed to be the reason for the lack of natural light. The accessibility and aesthetics of the garden need to be improved to provide a more enjoyable space for people who live at the home to sit and relax. People need to have a greater opportunity to access the wider community including outings and events to provide stimulation and points of interest. The Registered Person needs to provide opportunities for people who live at the home and their relatives to comment on the care and service they receive, and this information then used to develop the service, and to explore how information can be shared such as through the introduction of newsletters and events. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 considering moving into Willows Court cannot rely on the written information available to them as it is out of date and inaccurate, the assessment process to determine the needs and views of people has been reviewed. Evidence: We wanted to look at the information provided to people who use the service to find out whether it was detailed and answered all their questions. We found that the Statement of Purpose and Service User Guide which contain information about the home has not been reviewed which we highlighted at the previous Key Inspection, this means that anyone considering moving into the home cannot rely on the written information available to them. The Registered Manager said this would be addressed in the very near future. The assessment process for people considering moving into Willows Court has been reviewed to provide if completed well a wide range of information which will enable Care Homes for Older People Page 11 of 34 Evidence: the Registered Manager to determine whether the needs of someone can be met at the home, and be used to develop a care plan. The Registered Manager said that she will undertake all assessments and will visit people before they move into the home, and that she will carry out assessments on people whose care is funded by Social Services and those who fund the care themselves. The Registered Manager told us that their have been no new admissions into the home since the last key inspection, we therefore could not see how the assessment process worked for people moving into the home. We looked at the records of three people living at the home and found that the new assessment form is being used to review the needs of people already living at Willows Court and that in some instances Social Services have also reviewed the needs of people whose care they fund. Care Homes for Older People Page 12 of 34 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 adequate 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 recorded and monitored, improvements to care plans supporting people with dementia could improve the care and well-being of people at the home. Evidence: We wanted to find out how the health and personal care needs of people living at the home were met. We spoke with people living at the home along with visitors, we also observed the care and support provided by staff and looked at the care plans and records of three people. We spoke with one persons whose records we viewed and asked them for their views about the care they receive they said good care, but would like more carers so that I could go out more. they went onto say that the staff were good. We spoke with relatives and friends of people living at the home and they told us that they had no concerns about the care and that they found care staff to be supportive. One visitor said perfect, dont think they could get any better, its like a first class hotel and the staff are marvelous. Care Homes for Older People Page 13 of 34 Evidence: We looked at the care plans and records of three people and found that Willows Court now has a new care plan layout that is more comprehensive. The care plans that we looked at were reviewed monthly, and where practicable the person had signed their care plan. Care plans contain information that helps care staff to understand the needs of people living at the home, and any views of the person themselves are recorded. We found that daily records were well written and included when people at the home declined support. There were separate records which recorded peoples contact with health care professionals, and information included the advice and instructions given by the health care professional along with what actions the staff needed to carry out. Care plans were supported by risk assessments, which focused on specific areas where a potential risk had been identified, which included personal care and moving and handling, smoking and falls. The revised assessment and care plan format includes a range or risk assessments to cover topics including the self administration medication. Training records we looked at showed that senior staff and some care staff have received training on risk assessment. We spoke with staff who were working at the home when we visited, they told us that they had received guidance from the management consultancy firm and the Registered Manager about how to use care plans well, and what information needs to be recorded. Staff told us that they are now more aware of their role and responsibility and are able to work together well to improve the care and support people living at the home receive. We observed staff supporting people throughout our visit with personal care and offering support. We saw staff using correct moving and handling techniques which included the use of equipment. Staff were attentive throughout our visit and regularly checked on the well-being of people at the home. We looked at the medication and medication records for the three people whose records we had viewed, we found that both were being managed well. Staff training records show that staff responsible for the administration of medication have received training. When we visited no one at the home was prescribed a Controlled Drug, Willows Court has a separate storage facility for the storage of these. Recent changes to legislation mean that the Registered Person needs to ensure that the way in which Controlled Drugs are stored and managed is satisfactory. Care plans could still be improved to include preferred daily routines of people along Care Homes for Older People Page 14 of 34 Evidence: with greater information about how they wish their care to be provided. People with dementia or other specific needs need to have a care plan that enables staff to understand their role in supporting people within these areas to ensure that the lifestyle people receive promotes their well-being. We spoke with the Registered Manager and looked at training records, and found that both the Registered Manager and staff have accessed training which should help them to support and care for people, training included Dementia Care in a residential setting, moving and handling and infection control, the effectiveness of this training needs to be monitored by the Registered Manager to ensure that training received benefits the care people receive. Care Homes for Older People Page 15 of 34 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. People need to have access to a wider range of activities and opportunities to access events within the community and have their independence and choices supported at mealtimes. Evidence: We wanted to find out about how people spend their day, and how the staff working at the home support people to make decisions and stay in contact with relatives and friends, we did this by observing people throughout the day, talking with people living at the home and by looking at the care plans and records of three people. When we arrived some people were having their breakfast, whilst others were still in their bedrooms or sitting in one of the lounges, we sat in the dining room with people who were eating their breakfast and talked with them. One person said that they were looking forward to pay day so that they could go out with their friends to the local public house. We noted someone asking for more toast which was provided, we suggested to the Registered Manager that to promote the independence of people, if toast was placed in racks on the tables along with butter and preserves, and pots of tea or coffee then people could serve themselves, where appropriate and safe to do so. We saw one member of staff supporting someone to eat their breakfast, which was Care Homes for Older People Page 16 of 34 Evidence: done sensitively, the member of staff offered encouragement and spoke to the person throughout the meal. We saw people receive visitors throughout the day, and visitors we spoke with made positive comments about the care and approach of staff at the home. We saw relatives sit outside in some instances with people they had come to visit as it was a warm and sunny day. One group of visitors said that it would be good if the garden could be improved and tables with parasols purchased to shade people from the sun. We spoke with the Activities Organiser who visits Willows Court three days a week, she showed us the activity files and records which she has for each person. They told us that they had spoken with each person to find out what their interests were, and what they would like to do. Records showed that people have engaged in activities which are mostly on a one to one basis. We observed someone going out for a walk with the Activities Organiser and also saw her support people to read newspaper articles and complete word and number puzzles. A trip to Rutland Water Park has been arranged and several people we spoke with said they would be going. We noted that some people read newspapers or a book, whilst others watched television or slept in an armchair. One day a week an external organisation visits the home known as Learning Fourth Age, which provides one to one support helping people to learn about things of interest to them, we noted in the hallway a newspaper article which was about one person who lived at the home being supported to learn about their place of birth. We noted that people who live at the home started to be seated for their lunchtime meal at 11:40, however lunch was not served until 12 Noon, given that when we arrived at the home some people were still eating breakfast at 8.30 the time between breakfast and the lunchtime meal is limited. We saw people being asked what they wanted to eat, their were two main course and dessert choices, which were written on the menu on the wall of the dining room, we discussed with the Registered Manager that for some people living at the home reading the information and choosing what they wanted to eat could be difficult due to their disability and providing additional support for example using photographs of meals to help people make a choice and be aware of the menu. We also spoke to the Registered Manager about meals being served to people ready plated from the kitchen, and we noted in some instances meals were put onto the table and then the person was told it was their. We suggested to the Registered Manager that to promote choice and independence if serving dishes were placed on Care Homes for Older People Page 17 of 34 Evidence: the dining tables along with jugs of drink then people could serve themselves. Care Homes for Older People Page 18 of 34 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 living at Willows Court have access to a complaints procedure but are not aware in all instances of how to use it, staff training has taken place which promotes the understanding of staff to support the rights of people at the home. Evidence: We wanted to find out how the staff at Willows Court promote the safety and welfare of people who use the service, written information supplied by the Registered Manager before our visit told us that the home has reviewed its Complaints Procedure and introduced a new complaints form. The self assessment tool completed by the Registered Manager also told us that staff have received training to help staff understand their role and responsibility in safeguarding vulnerable adults, and raising any concerns they may have. We noted that the complaints procedure is displayed on the wall in the entrance foyer, and we asked people living at the home if they knew how to complain, the answers they gave were conflicting with some people saying they would speak with staff whilst others said with a member of their family. Willows Court has received one complaint since the last key inspection, this was recorded along with the outcome and feedback given to the complainant. We looked at staff training records and found that the Registered Manager along with a majority of staff have received training which will enable them to understand and Care Homes for Older People Page 19 of 34 Evidence: support people living at Willows Court by having a greater understanding as to how they need to work with people to maximise their rights and choices. The training they received was on the Mental Capacity Act and senior staff including the Registered Manager had received training on Deprivation of Liberty Safeguards. We looked at the staff recruitment records for the 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 show checks were carried out on applicants to make to make sure they were suitable to work with vulnerable people, known as as the Criminal Records Bureau (CRB) disclosure. The staff rota viewed was reflective of the staff working on the day, we noted their is one agency member of staff who works regularly on a night shift, working alongside an employee of Willows Court. Since the last key inspection the Registered Person and Registered Manager have continued to work with Social Services and have involved a consultancy firm, to work alongside them, to resolve the issues identified previously as areas for concern. This was overseen by Social Services who are responsible for ensuring that vulnerable adults are safeguarded. Meetings held involving Willows Court, Social Services and representatives of the Care Quality Commission have continued and have now concluded that the safeguarding concern has been dealt with and that sufficient improvements in the home have taken place, which will for the near future continue to be monitored to ensure improvements and recommendations made continue to be implemented. Care Homes for Older People Page 20 of 34 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. Willows Court had improved the home to provide a homely and comfortable environment for people to live, improvements are needed to promote the safety and quality of lives for people in some bedrooms in the home. Evidence: We had a tour of Willows Court and looked at all communal areas of the home and a majority of the bedrooms, we did this to find out what improvements have been made since the last key inspection, where areas of concern were found including cleanliness and infection control issues. The lounge and lower lounge were in good decorative order with new armchairs and flooring, the dining room had been painted but was still waiting for curtains to be hung. The dining room has patio doors which lead into the conservatory, we noted that the gap which was identified previously as a potential trip hazard has been reduced, with only a small gap remaining to allow the patio doors to open and close. The conservatory could benefit from improvements to include new blinds and furniture. Bedrooms had been painted and new carpets and curtains fitted along with new coordinated bedroom furniture that included a bed, wardrobe, draws and bedside cabinet. The bed covers, curtains and armchair were also co-ordinated with reference Care Homes for Older People Page 21 of 34 Evidence: to the fabric and colour. All but one bedroom at the home has an en-suite facility which consists of a wash hand basin and toilet, a majority of these have been re-tiled and new toilets and sinks installed, the Registered Manager said that this would be undertaken in all bedrooms. We noted when we looked into the en-suite of an unoccupied room that their was an infestation of ants, the Registered Manager contacted the company the homes contracts with to deal with this issue, and they visited that day and dealt with the problem. Willows Court has some bedrooms which are shared rooms, and we noted that whilst these were unoccupied at the time of our visit a privacy screen or curtain was not in place. We observed that should the screen or curtain be installed the division of the room space would not in all instances be equal to both occupants, and that the furniture such as wardrobe and arm chair would not be accommodated within a persons individual space. The previous key inspection noted that bedrooms to the lower ground floor to the rear of the property were very dark and lacked natural light, we found this still to be the case. The Registered Manager said that the trees and shrubs had been pruned but this had made little or no difference. The lack of available natural light in these rooms mean that anyone considering staying in these rooms is at greater risk of a fall or accident, and would need to be considered when assessing the needs of someone considering moving into the home, and should be reflected within the information supplied by the home known as the Statement of Purpose and Service User Guide. The Registered Person needs to take all reasonable steps to increase the natural light in these rooms, which should include the removal of the trees and shurbs. We noted that concerns identified at the previous key inspection about infection control concerns had been dealt with and we found that soap dispensers contained liquid soap, and that individual toiletries were kept within peoples own bedroom and not left for others to use. We also found that prescribed creams and other ointments were now kept within the medication trolley to reduce the risk of infection. Bacterial gel dispensers are located in communal areas in the home, and staff and visitors are encouraged to use them to reduce infection within the home. Care Homes for Older People Page 22 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Willows Court are supported by staff who have undergone a robust recruitment process and are employed in sufficient numbers to meet their personal care needs and have received training relevant to their role. Evidence: We wanted to find out whether the number of staff working at the home and the training they receive enables them to care and support people who live at Willows Court effectively. We did this by looking at the staff rota, through observation and by looking at training records. When we arrived at the home their were three care staff on duty, which included a senior carer, along with staff who were working in the kitchen preparing breakfast and the lunchtime meal. At the time of our visit their were thirteen people living at the home. Many people were already up when we arrived, eating breakfast or sitting in one of the lounges. The Registered Manager and the joint owner of the home arrived shortly after our arrival, as did the Activities Organsier and a cleaner. Care staff were able to focus on the needs of people living at the home, with the Activity Organiser and other staff undertaking their specific roles and responsibilities, in the afternoon we noted that care staff had time to encourage people in one to one activities such as numeracy puzzles. Staffing levels at the time of our visit were able Care Homes for Older People Page 23 of 34 Evidence: to meet the needs of people living at the home, but the number of staff on duty would need to be increased should more people move into the home. The Registered Manager told us that they were in the process of recruiting additional care and cleaning staff. We looked at the training records of staff along with the information provided by the Registered Manager in the self assessment tool, which told us that 31 of staff have attained a National Vocational Qualification in Care. We found that their has been a significant increase in training undertaken by staff at the home in this current year. Training records show that this has focused on specific areas which include health and safety including infection control and moving and handling, training linked to care practices which includes administration of medication and dementia awareness, along with training to promote peoples rights which include Deprivation of Liberty Safeguards and the Mental Capacity Act. Through discussion with staff we found that staff feel more involved in the day to day running of the home, and that the training they have received along with the guidance provided by the consultancy firm has enabled them to have a greater understanding as to their role and responsibility in providing good quality care. Staff said that they receive regular supervisions, which enable them to discuss specific issues including ways of working, whilst senior carers told us that they have weekly meetings to discuss good practice. 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. We looked at the staff records for the staff who were working in the home on the day or our site visit which evidence that staff are recruited using satisfactory procedures. The Registered Manager told us that induction training is now provided by Skills for Care, and the training that staff have received this year, has been provided in the main by this organisation along with distance learning courses. Care Homes for Older People Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of Willows Court has improved which has improved the care and support people receive, further opportunities need to be created for consultation with people who live at the home and their relatives so that their views are used to continually develop the service for the benefit of people living at the home. Evidence: The Registered Manager of Willows Court Miss Rebecca Keightley has completed a National Vocational Qualification at level 4, and she told us that she will be commencing a management course at college in September 2009. We looked at training records and found that Miss Keightley has attended various training up to and including June 2009, which enables her to undertake and understand her role and responsibility as the Registered Manager. The training she has attended focused on specific areas which include managerial responsibilities, the promotion and understanding of service user rights, health and safety topics, and topics linked to the care of people living at Willows Court. Care Homes for Older People Page 25 of 34 Evidence: The Registered Manager completed a self assessment tool as part of the inspection process, which contained information we needed. The level of information provided could be improved by including how the management of the home such as training impacts on the care and support people receive. We spoke with Miss Keightley about the training she had undertaken, and she spoke with enthusiasm and told us that she particularly enjoyed undertaking the training which supports the rights of people living at the home, which included training on the Mental Capacity Act and Deprivation of Liberty safeguards, and she was able to tell us how the training she had received would be used in day to day practices, which included identifying people at the home to be referred to the Deprivation of Liberty Safeguard team. The Registered Manager discussed the training they had received with regards to dementia awareness, and when we discussed the further development of care plans for people with dementia and recording peoples preferred daily routines, she was able to tell us about how the training she had attended supported this area of improvement. We observed the Registered Manager throughout the day offering guidance to staff on good care practices as well as speaking with visitors to the home. We also saw her meet with a contractor to discuss the improvement of the garden. Staff told us that they have a greater understanding of their role and responsibility within the home, and that staff supervisions and meetings enable them to keep up to date and discuss the day to day issues within the home. The Registered Person has employed on a temporary basis the services of a management consultancy firm to support them and the Registered Manager in developing Willows Court to improve the care and support people at the home receive and review how the home is managed, which included looking at the paper work and day to day management issues. This along with the training staff have undertaken has improved how the service operates on a day to day basis and the outcomes for people living at the home. The Registered Manager told us that surveys had been sent to people who live at the home and their relatives seeking the views of people, to date three had been returned, we viewed these and found them to be generally positive. We noted when we arrived that on the wall of entrance foyer was a list of dates for meetings for people who live at the home and their relatives and friends, however the Registered Manager told us that no one had attended the first meeting. Care Homes for Older People Page 26 of 34 Evidence: We discussed the development of quality assurance and suggested that newsletters could be away to keep everyone informed about what is happening in the home, which could include information about staffing, improvements to the home, activities and planned events. The Registered Manager said they would consider this idea. The Registered Person now visits the home monthly and speaks with people who live at the home, visitors and staff as well as looking at various records and undertaking a tour of the building. The Registered Person then produces a written report which the Registered Manager has a copy of that details the outcome of their visit along with any actions needed to be undertaken to address any issues identified. Staff we spoke with along with information detailed with the self assessment tool completed by the Registered Manager told us that staff are regularly supervised and meetings are held frequently to discuss care practices and the day to day running of the home. We discussed with the Registered Manager areas of risk which had been highlighted at the previous key inspection. We noted that window restrictors are now fitted on windows in the home and other concerns with regard to infection control have been addressed. We looked at the report completed by the Environmental Health Officer in March 2009, and noted that requirements and recommendations made had been acted upon. Information the Registered manager supplied prior to the site visit details the regular maintenance of equipment and systems in the home, including heating and electrical systems along with fire fighting equipment and systems. Care Homes for Older People Page 27 of 34 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 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 25 23 Regulation 23(2)(p). The 21/04/2009 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 23(2)(p) of the Care Homes Regulations 2001. 3 25 23(2)(p) The Registered Person to 18/06/2008 ensure that there is sufficient natural light in the bedrooms to the rear of the property to Page 28 of 34 Care Homes for Older People 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 ensure the safety and well being of people using the service. Care Homes for Older People Page 29 of 34 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 5 The Registered Person to review the Service Users Guide so that it contains up to date and accurate information about Willows Court and the service is provides. To assist people in making an informed decision as to whether Willows Court can meet their needs. 31/07/2009 2 1 4 The Registered Person to review the Statement of Purpose so that it contains up to date and accurate information as detailed within Schedule 1 of the Care Homes Regulations 2001. To assist people in making an informed decision as to whether Willows Court can meet their needs. 31/07/2009 3 7 15 The registered person to develop care plans which 31/07/2009 Care Homes for Older People Page 30 of 34 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 provide information and guidance as to how someone with dementia is to be supported. All care plans to include individuals preferred daily routines To promote the well-being of people. 4 9 13 The registered person to 31/07/2009 establish that the cabinet which is used to store Controlled Drugs at Willows Court complies with the Misuse of Drugs (Safe Custody) Regulation 1973. If it is found current storage facilities do not meet the regulations then a storage system, which does comply with the Misuse of Drugs (Safe Custody) Regulation 1973 is to be purchased and installed as per the regulation. To ensure the safe storage of Controlled Drugs. 5 25 23 The registered person to 31/07/2009 consult with an Environmental Health Officer to establish whether the natural light in the rear bedrooms of the home meet with their requirements for the health and safety of people. Care Homes for Older People Page 31 of 34 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 To take all reasonable steps to ensure that people have sufficient natural lighting to carry out daily living tasks and promote their safety and well-being. 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 The Statement of Purpose and Service User Guide to be produced in a format which assists people with varying needs to understand the information provided and make an informed choice. People need to have the opportunity to access a wider range of community activities with increased frequency on an individual and group basis. Independence and choice for people at Willows Court could be promoted if the menu was displayed in pictorial format for those who find it difficult to read the information on the menu board. Independence and choice for people at Willows Court could be promoted by encouraging people to serve themselves from serving dishes or other food receptacles placed on dining tables. To promote the rights of people living at Willows Court, everyone living at the home and their relatives/friends be given a copy of the homes revised Complaints Procedure. The garden area be improved by ensuring it is accessible to people who live at the home, and by introducing plants and shurbs of interst for people to view. Seating and tables are provided, which include protection from the sun. Conservatory to be improved by purchasing new blinds and furniture for the comfort of people at Willows Court. 2 13 3 15 4 15 5 16 6 19 7 19 Care Homes for Older People Page 32 of 34 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 8 21 Bathroom on the lower ground floor to the rear of the building to be improved with new bathing/shower facilities and suite which meets the needs of people at the home along with new flooring and tiling. Consultation to take place with recognised professionals with the necessary expertise to increase the natural light of bedrooms to the lower ground floor to the rear of the property, with consideration to consulting with a tree surgeon and environmental health officer. A newsletter be developed which is circulated to people who live at the home and their relatives and friends that provide information about the home including information on staffing, activities and events and other useful information such as how to complain and details of advocacy services. 9 23 10 33 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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