Inspection on 29/05/09 for Willows Nursing Home, Blacon

This inspection was carried out on 29th May 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willows Nursing Home, Blacon 01/05/07

Willows Nursing Home, Blacon 18/10/05

Willows Nursing Home, Blacon 14/04/05

Willows Nursing Home, Blacon 08/12/04

Willows Nursing Home, Blacon 07/06/04

Willows Nursing Home, Blacon 12/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willows Nursing Home, Blacon Treborth Road Blacon Chester Cheshire CH1 5RP     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: Anthony Cliffe     Date: 2 9 0 5 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 35 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 35 Information about the care home Name of care home: Address: Willows Nursing Home, Blacon Treborth Road Blacon Chester Cheshire CH1 5RP 01244374023 01244379228 manager.willows@m-a.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mohammed Hussain,Mrs Anwar Hussain,Mr Naveed Hussain Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 73 Number of places (if applicable): Under 65 Over 65 50 23 dementia old age, not falling within any other category Additional conditions: 5 0 Bedroom numbers 8, 27, 64 and 65 only may be used to accommodate two persons The home is registered for a mximum of 73 service users to include: * 50 persons in the DE(E) dementia over 65 years of age, category. * Within the 50, a maximum of 5 persons in the DE, dementia under 65 years of age category. * 23 persons in the OP, older persons, category. Date of last inspection Brief description of the care home Willows Nursing Home is a single storey building situated in the Blacon district of Chester. The home is conveniently situated for local shops and other communal facilities in Blacon, and there is regular public transport into Chester city centre. The Care Homes for Older People Page 4 of 35 Brief description of the care home home provides nursing care for 23 older people whose needs are due to physical frailty, and fifty people who have dementia. The home is part of a small group of homes owned by the registered providers. The home has 65 single bedrooms, 26 of which have en-suite facilities, and four bedrooms, which may be shared by two people. Externally the gardens are landscaped and additional car parking facilities provided. All rooms and areas, including the gardens, are spacious and are accessible to wheelchair users. Fees range from four hundred and sixty seven pounds to five hundred and twenty pounds per week. Information about the home can be obtained by contacting the care home directly. Care Homes for Older People Page 5 of 35 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: References to we, our or us represent the Care Quality Commission This unannounced visit took place on the 29th May 2009 and lasted over seven hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service Care Homes for Older People Page 6 of 35 they provide in the same way we do and if our judgements are consistent with home owners or managers. During the visit various records and the premises were looked at. People that use services, staff and the managers were spoken with and gave their views about the service. We provided questionnaires to people using the service, staff and health and social care professionals involved in their care so they can tell us their views about the service the home provides. In May 2008 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since out last visit or annual service review. What the care home does well: What has improved since the last inspection? What they could do better: An application to register as the manager must be made to the Care Quality Commission so that we and the people that live and work at Willows will be confident the home is run in their best interest. The home must improve how it gathers important information about the needs of people that use services before they move into the home so staff have important Care Homes for Older People Page 8 of 35 information and can plan how to meet their different needs. People that use services must be asked about their social interests and offered the opportunity to be involved in recreational and social activities of their choice so they can live fulfilling lives. Safe systems for supporting people that use services to walk safely must be in place so they are supported with their mobility needs and the risk of them falling is reduced. The recruitment of staff and training on safeguarding adults must be improved so people that use services are protected from harm. Quality assurance must improve so mistakes made in managing the health needs of people that use services, monitoring of the health needs of people that use services, management of controlled drugs, recruitment of staff and training in safeguarding adults are not repeated so the home is managed more effectively and the welfare of people living there maintained. The home should provide information in the statement of purpose, service user guide and complaints procedures in different ways that people with memory problems can understand and have access to so they receive useful information on the facilities and services and have confidence they can make a complaint so their concerns are listened to and acted upon. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Staff practice should improve about how people that use services choose to protect their personal appearance during meals times so senior managers and the owners are aware where staff performance and training needs to improve so people that use services are treated with dignity and receive skilled care at all times. People that live at the home and their relatives should be asked, through meeting with them or other methods, what they think about the quality of the facilities and services offered at Willows so improvements they would like to be made are done. There should be regular staff meetings with the manager to discuss the management of the home, personal development, training and areas for improvement so staff have the opportunity to contribute to their own personal development as well as that of the home. 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 Care Homes for Older People Page 9 of 35 7535. Care Homes for Older People Page 10 of 35 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 11 of 35 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. Information provided to people that use services about Willows needs to be more accessible so they can decide if the home is suitable to meet their needs. Insufficient information is gathered about the needs of people that use services, which means that the home cannot show that it can meet their needs. Evidence: The information the home uses to describe the care and facilities it provides, called the statement of purpose, says that the home offers day care, respite care and transitional care so people that may choose to live at the home are aware of the care needs the home can care for. The information provided to people that use services called the statement of purpose or service user guide is not available in any other formats so people who have visual impairments or whose first language is not English do not have access to alternative languages, large print or audio versions. This means that people that may choose to live at the home do not always know what services or facilities are Care Homes for Older People Page 12 of 35 Evidence: available to them. Before the visit five people that use services returned surveys to us and three said that they received information about the home that helped them to decide to live there, so they confirmed they received information to help them decide the home could meet their needs. We could see that the home had not gathered sufficient information on two of the three people whose care we looked at. No information had been obtained about them before they moved into the home other than brief information provided by the hospital when they were discharged. This means that the home did not have important information on which to plan their care or prove they could meet their needs. The third person had more detailed information about their needs gathered. We saw this covered information about their social interests and hobbies, medical information on their physical and mental health, how they communicated with people, maintaining their safety, managing finances, help with personal care, and the life histories of people as some examples, so where information had been gathered staff had information about the people they cared for and supported. The deputy manager said information had not been provided by the local NHS Primary Care Trust who placed the two people in the home under an agreement to use beds to prevent people having to be admitted into hospital and be placed in the care home while decisions as to whether they could be cared for at home or needed residential or nursing care could be made. The manager had not agreed with the NHS trust who was responsible for getting or gathering the right information about people that use services before they moved in so the home allowed someone to move into the home they did not have the experience to provide appropriate care for. Care Homes for Older People Page 13 of 35 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. Care practice needs to improve about how information and guidance about the health of people that use services is followed so their health is promoted at all times. Information held about people that use services does not support that they are directly included in the decision making process so are not always involved in everyday decisions. Recording arrangements for controlled drugs needs to improve so they are managed safely. Evidence: The information the manager sent to us before the visit said that people that use services receive individualised care plans written by trained and experienced staff and involved people that use services and other with an interest in their care. The care plans we saw gave details as to the personal care needed by people that use services but did not always reflect their preferences or routines about how they wanted their personal care to be arranged. This means that care based on their personal preferences was not provided, for example routines around bathing. Care plans did provide staff with some guidance on supporting people to remain independent by Care Homes for Older People Page 14 of 35 Evidence: encouraging them to choose their clothes and saying they liked to remain smart in their appearance. Care plans included details of the health and social care professionals involved in peoples care. Care plans and daily records showed that staff acted on recommendations from professionals such as psychiatrists and speech and language therapists. However care plans did not always agree with other information written about people that use services. Examples of these were that nutritional information called a nutritional assessment and a care plan said a person using the service did not have problems with eating and when the plan was reviewed to see if it was working the review said the plan was working well and no changes were needed to the persons care. When we looked at the records for the persons weight we saw the person had lost over 4 kilogrammes in over a month so records were inconsistent. Another example was the records of a person using the service had information about being at risk of falls and guided staff that the person must be helped when walking to prevent them from falling. This information was consistently recorded in documents called risk assessments used to identify if people may be at risk to themselves or to others due to them not being able to recognise they are at risk. We saw the person had fallen and was not seriously injured. When we looked at the accident records we could not see if the risk assessments were being followed and the person was being helped to walk. Daily records of the account recorded the person was walking without help from staff so staff were not following the guidance in place and preventing people from falling. The home has a weekly surgery from a general practitioner and practice nurse so the health needs of people using the service are regularly looked at. The home said it had problems accessing dietitians as the local hospital was understaffed and locally there was no community dentist but people were seen regularly by the nursing home doctor so could access services when needed. The home completed nutritional screening on everyone admitted to the service and repeated this so people that were at risk of malnutrition were regularly monitored and the necessary action taken where people were at risk. We examined the care plans of three people that use services. We could see that the home were using new documents in which to record information about people that use services, what their needs were and how staff would provide care and support to people that use services. The home does not use person centred planing. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should Care Homes for Older People Page 15 of 35 Evidence: be included about what and who is important to people that use services from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported to stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. The information the home had about people that use services was about their needs, routines and lifestyle but this information was not reflected in the care plans the home had written to support and provide care for them so staff did not have information to provide individual care. Care plans did not reflect a person centred approach and only contained a little information on how people could care for themselves or be involved in their personal care so did not support a person centred approach. We could see many examples of how people that lived at the home chose their daily routines and followed their own lifestyles but this was not reflected in the care plans written about them and we could not see how they had been involved in the writing of their care plan so would not know what was written in them. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported and saw staff help them make decisions. We did not see information about how people that use services made decisions or where they lacked capacity, experience or judgement to make decisions so could not confirm why, when, where and how staff supported them to make decisions or what decisions they made for them or supported them to make. Medication policies and procedures were detailed so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. Both units had the same medicine storage facilities and procedures in place. Medicine fridges were available with the operational temperatures of the drugs fridges regularly recorded so staff knew they were operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and found no errors, so people that use services were receiving their medicines safely. We looked at the arrangements for the ordering, receipt, administration and disposal of controlled drugs. We found that controlled drugs were generally managed safely but we found mistakes were made in the recording of the correct amounts of some controlled drugs received so the amounts recorded as being in stock were incorrect. We found controlled drugs stored and no records they had been received into the home so records of receipt were incorrect. Care Homes for Older People Page 16 of 35 Evidence: We talked to staff who were administering medicines about the arrangements for giving out medicines during mid morning which seemed to add to this busy time of the day. Staff said it took over two hours some mornings to administer medicines to people that use services so they were not available to support and supervise staff. Staff agreed to look at the arrangements for the administration of medicines to fall into line with good practice where medicines were given at times chosen around the routines of people that use services. Care Homes for Older People Page 17 of 35 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 that use services are supported to make choices but could be offered more opportunities for recreational and social contact so they have control over their lives based on their personal choices. Evidence: A notice board at the main entrance displayed the range of activities available in the home for a month. This also displayed the complaints procedure as well as cards of thanks from relatives. Outside entertainment was provided by visiting entertainers. Local clergy visit the home to speak with people living there so they have opportunities to practice their faith. Since the last visit the home had recruited an activities coordinator so there was someone to plan and encourage people to do activities. The manager said the activities coordinator was working between 10:00 and 17:00 Monday to Friday and every fourth week worked a Saturday or Sunday so could provide flexibility around planning and providing opportunities for activities. We saw some people that use services reading newspapers and magazines, watching TV and listening to music. We did not always see staff sitting and talking with people that use services so they did not always have social contact. Care Homes for Older People Page 18 of 35 Evidence: The majority of people living at the home were seen to be sleeping so not engaged in doing anything. The information sent to us before the site visit said that the home had set up a relatives support group. The manager said the meetings has commenced so they offer families an opportunity to say what they want from the home and include this into care for people living at the home. We spoke to the activities coordinator and saw she had time so sit and talk to people living at the home, serve drinks and assist people to eat and did beauty therapy. The activities coordinator said she had been involved in playing dominoes in the morning and in the afternoon was doing beauty therapy as some of the ladies had asked her to do their nails. We saw staff sitting in the lounge in the dementia care unit writing daily records but not speaking to people that use services who just sat watching television or were engaged with their own tasks so staff practice was poor. We did not see staff involved in activities or sitting talking with people living at the home other than to provide personal care or help as meal times so did not have time to be involved in social activities. Throughout the day we saw examples of people that use services sitting in chairs sleeping or looking at a television. The more active people living at the home were able to sit in the garden as the weather was sunny. A person using the service said of the opportunities to socialise, I wouldnt have a wrong word said about here, no complaints not a wrong word. Its great with lovely friendly staff. I get what I need have good food and live in nice surroundings. I do get fed up though, thats the only thing not much to do. I recently was ill but no one asks me about this or says how are you doing so I get down then angry with myself. No one sees that or comes to talk to me which would be a huge help. I find talking to the staff when they have the time eases my anger. The routines of the home were seen to be flexible and meals were seen to be varied and supported a balanced diet with advice sought from dietitians where necessary. The home has varied arrangements for meal times which included two sittings so plenty of time is allowed for people to eat their meals. We shared lunch with people that use services. People were served directly from the kitchen and were offered a choice of fish, chips and mushy peas or savoury mince. Sweet was a choice of ice cream or home made cheesecake or flan so people had a varied menu from which to choose. Comments from people that use services about the meals were,We always receive nice food and are very lucky here, Im so full I couldnt eat for another month, The girls do well we are never disappointed and theres always a choice I can have. Staff showed people the choices of meals available to them so encouraged them to Care Homes for Older People Page 19 of 35 Evidence: make a choice. People that use services said if they wanted small or larger portions. Details of meals available were written on the notice boards in each unit so people that use services had information about the meals on offer. This also contained information on the day, date, month and year as well as staff on duty so people that use services were supported to be up to date with everyday information. We saw people that used services wore blue plastic aprons during meal times, which staff placed on them without anyone being asked if they wished to wear one so their choices were not sought on this decision and their dignity not upheld. A person using the service said, They put them on you to stop you getting your clothes dirty, but Im not a baby. They do it with the best intentions but dont ask you if you want one on or give you a choice just put them on you. Care Homes for Older People Page 20 of 35 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 that use services are not always protected by the safeguarding adults procedure in place so people that use services will not be protected at all times. Evidence: The information sent to us by the manager before the visit said the home had received five complaints. When we spoke to the manager about the complaints she confirmed these were not complaints but concerns raised which had led to the safeguarding adults procedure being used on five occasions so the home had not received any complaints. The complaints procedure was displayed at the front entrance to the home for people that use services to use. People that lived in the dementia care area of the home have electronic locks on the door preventing them leaving the area so would not be able to have access to the complaints procedure so could not use it. Before the visit six people that use services returned surveys to us and all said they knew who to speak to if they were unhappy and three knew how to use the complaints procedure. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. The manager said that all but five staff who had recently commenced employment at Care Homes for Older People Page 21 of 35 Evidence: the Willows had received safeguarding training. Staff had received training using a DVD on how to recognise and respond to suspicions of abuse so should be able to protect vulnerable adults. We spoke to four staff and all of them said they had not had had safeguarding adults training so could not respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. The deputy manager confirmed that the registered nurses employed at the home had not had training in safeguarding adults as required. The home had a copy of the local authoritys safeguarding adults procedure and had access to the local councils safeguarding adults training programme through the local training consortium. The home had recently had five safeguarding adults investigations completed and had cooperated with the local council in the investigation of these. One of the concerns raised was that staff were not telling the local council or other agencies about the events which took place so they were not being reported and the home was not learning from mistakes made. The manager had not repeated safeguarding adults training following the recent investigations so all staff would not understand the safeguarding adults procedure. She said the concerns over the reporting of safeguarding issues had improved and had been discussed with all staff during handover. Staff were also issued with the General Social Care Council code of practice, a guide for social care staff on the standards expected of them so they were aware of their responsibilities and practice when providing care to people that use social care services. Staff also had access to the whistle blowing policy, which is a policy they could follow if they needed to tell members of the public or other organisations about things in the care home that concerned them and needed to be placed in the public interest. Care Homes for Older People Page 22 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services live in a comfortable and safely maintained building so their health and safety is promoted. Evidence: We looked around the home and saw that improvements had been made since our last visit. In the elderly frail unit the corridor and lounge carpets had been replaced as well as a number of bedroom carpets. A notice board had been put up and this contained the activity schedule for the month as well as photographs of events that had taken place in the home and thank you cards from relatives. All the bedrooms in the elderly frail unit had also been redecorated and new curtains and furniture purchased for each bedroom. New ceiling lights has been fitted throughout the corridor areas and these gave a brighter look to the corridor areas. In the dementia care area of the home the whole area had been redecorated in different colours to either enhance or calm the environment down. The deputy manager said she had done some research and chose colours that either helped people that use services to calm down or to lift their mood. Bathroom and toilet doors had been painted different colours to help people that use services to recognise they were not a bedroom or cupboard but they did not all have a sign or symbol on them to help people that live there to recognise they were a bathroom or toilet so people might not Care Homes for Older People Page 23 of 35 Evidence: be able to recognise them as toilets or bathrooms. Bedroom doors had also been painted different colours and some had the names of the people who occupied bedrooms on them but they did not have a picture of the person or other things they might recognise to help remind them it was their bedroom so might not be able to recognise their bedrooms. Some doors had been painted the same colour as the corridor walls to discourage people from entering rooms where items may be stored or disposed of, so would be safe from harm. Care Homes for Older People Page 24 of 35 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. Employment procedures need to be improved so people that use services are protected by a thorough recruitment process. Evidence: We saw the staff numbers in place supported the needs of people that use services so they had sufficient help with their needs. There were three registered nurses and six care staff staff on duty as well as the manager and deputy manager. Additional staff were later on duty to assist with domestic, laundry and catering duties. The manager works at the home five days a week and is not included in the staff on duty so is able to offer support and supervision to the staff team. The home had been using agency agency staff to cover shifts and had used staff from one agency so people that use services had continuity of care. The home had recruited new staff and was waiting for the necessary checks to be completed on others. The home use a staff handbook based on Skills for Care induction standards, which are national standards for social care staff for the induction of staff employed at the home. This has been introduced since the last visit and all staff including those who have been employed on a long term basis have to work through this so they understand their roles and responsibilities. The home employs 28 care staff and 11 of these have an NVQ level 2 qualification. A further 9 staff are working toward the completion of the Care Homes for Older People Page 25 of 35 Evidence: NVQ level 2 qualification. An NVQ level 2 qualification is a nationally recognised qualification in social care. We examined the recruitment records of four staff employed at the home. Recruitment procedures were generally good and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. The home had recruited staff from the European Union and had all the necessary documents translated into English so we could see they had carried out thorough checks on people but once the staff had a permanent address in the United Kingdom they had not carried out a CRB check on them and one of the staff had been promoted to a different job within the home and had not had an up to date CRB check done. So the required checks on staff were not consistently carried out. Staff were provided with a variety of training which included health and safety, food hygiene, moving and handling, safeguarding adults and nutrition but staff training records were not all up to date so we could not confirm that all the necessary training had been completed. We talked to staff about their practice and they were confident about their skills and experience but some said they had not received safeguarding adults training so did not understand how to protect vulnerable adults. Before the visit staff returned surveys to us that said they received the training they needed so were able to do their jobs. Care Homes for Older People Page 26 of 35 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. Quality assurance could be improved so areas for further development are identified so the welfare of people that use services is promoted. Evidence: Before the visit the owner and manager informed us that the manager had resigned and the deputy manager was promoted to manager. The deputy manager had worked at the home for several years so there is consistency in the management arrangements for the home. We have not yet received an application from the manager to register as the registered manager so cannot yet confirm her suitability. The manager completed some quality assurance checks in the home audits as part of the quality assurance system. This included monthly health and safety checks of the building and a report sent to the owners so they know if any maintenance or decoration is needed. They also collect information on accidents in the home and send the information to the care home doctor who looks at the information as part of Care Homes for Older People Page 27 of 35 Evidence: reviewing the health of people that live at the home so their health can be looked at if needed. Weekly checks on medicine administration and storage commenced in April 2009 but these were not carried out consistently so did not find the problems we found with the management and administration of controlled drugs. The manager also did checks on the quality of the writing in and recording of information in the care plans of people that use services so she could monitor staff practice. Checks had been done in April and May 2009 and where errors were found the manager had identified who was responsible for the errors made and what actions needed to be taken to correct the records. The manager also looked at the records again to see the errors had been corrected. The quality assurance process did not identify issues around the poor practice we saw in some areas of the home for example use of plastic blue aprons and staff not interacting with people that use services so the quality assurance system does not cover important matters. As a result of consulting and listening to people that live at the home some improvements have been made with the introduction of a suggestion box and notice boards placed in all three main areas of the home which display information for people that use services so they are given information about what is happening in the home and are able to contribute to change. Positive changes have been made as a result of asking people that live at the home about what they would like to change. A relatives support group was formed which resulted in the introduction of the notice boards, an activity monthly planner, two sittings at meal times to reduce noise and confusion, decoration of the dementia care unit to enhance various moods and modernisation of communal areas. The manager had not used satisfaction surveys to ask people that live at the home, their relatives or anyone else who had an interest in their care what they thought about the quality of management and standards of care and facilities at the home since 2007 so information about the quality of management, care and facilities had not been gathered from all the people who have an interest in the care home. The manager held meetings in the home with all grades and levels of staff so staff had an opportunity to listen to and discuss important matters about the management of the home. There were senior managers meetings and staff meetings as well as monthly meetings with the owner. The meetings with senior managers and staff could be held more frequently as the last senior managers meeting was in December 2008 and last staff meeting in January 2009. The home had also achieved the Investors In People award which it has held for eight years. The Investors In People award award is a nationally recognised award for developing quality and investing in the development of organisations. Willows do not usually manage or keep personal monies of people living at the home Care Homes for Older People Page 28 of 35 Evidence: or act as an appointee for people that use services. Personal monies were managed by people using the service or their families. The home kept monies for a number of people that wished to deposit monies for personal use. The home kept records for any monies received and withdrawn and the amounts of these were checked by the manager and a witness so there were records of all financial transactions that had taken place. The AQAA confirmed that all the required maintenance and health and safety checks had been completed as required. We looked at the fire safety for the testing and maintenance of equipment and found these to be completed so people that use services live in a safe home. Care Homes for Older People Page 29 of 35 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 29 19(1)(a)(b)(c The manager must not ) employ a person to work at the care home unless she has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 so that residents are protected from harm. 01/05/2007 Care Homes for Older People Page 30 of 35 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 3 14 The home must improve how it gathers important information about the needs of people that use services before they move into the home. This is to make sure that staff have important information and can plan how to meet peoples different needs. 07/08/2009 2 7 13 Safe systems for supporting 08/07/2009 people that use services to walk safely must be in place. This is to make sure they are supported with their mobility needs and the risk of them falling is reduced. 3 9 13 Recording arrangements for controlled drugs must improve . To make sure that they are managed safely. 08/07/2009 4 12 16 People that use services must be asked about their 08/08/2009 Care Homes for Older People Page 31 of 35 social interests and offered the opportunity to be involved in recreational and social activities of their choice. This is to help make sure that they can live fulfilling lives in the home. 5 18 18 The training of staff on 09/08/2009 safeguarding adults must be improved. This is to make sure they know about abuse and what to do to make sure that people living at the home are protected from harm. 6 31 8 An application for the manager to become registered with the Care Quality Commission, as required by law, must be made. This is so that we and the people that live and work at Willows will be confident the home is run in their best interest. 7 33 24 Systems of quality 09/08/2009 assurance at the home must be improved. This is so that mistakes made in managing the health needs of people that use services, monitoring of the health needs of people that use services, management of controlled drugs, recruitment of staff and training in safeguarding 09/09/2009 Care Homes for Older People Page 32 of 35 adults are not repeated so the home is managed more effectively and the welfare of people living there is maintained. 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 home should provide information in the statement of purpose, service user guide and complaints procedures in different ways so that people with memory problems can understand and have access to useful information on the facilities and services and have confidence they can make a complaint so their concerns are listened to and acted upon. The home should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. Staff practice should improve about how people that use services choose to protect their personal appearance during meals times so senior managers and the owners are aware where staff performance and training needs to improve so people that use services are treated with dignity and receive skilled care at all times. The home should provide information in the statement of purpose, service user guide and complaints procedures in different ways that people with memory problems can understand and have access to useful information on the facilities and services and have confidence they can make a complaint so their concerns are listened to and acted upon. The home should ask people that live there and their relatives, through meeting with them or other methods, what they think about the quality of the facilities and services offered at Willows so improvements they would like to be made are done. The home should have regular staff meetings with the manager to discuss the management of the home, personal development, training and areas for improvement so staff 2 7 3 14 4 16 5 33 6 33 Care Homes for Older People Page 33 of 35 have the opportunity to contribute to their own personal development as well as that of the home. Care Homes for Older People Page 34 of 35 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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