Inspection on 16/06/09 for Willows Nursing Home Limited

This inspection was carried out on 16th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willows Nursing Home Limited 28/06/10

Willows Nursing Home Limited 21/04/10

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 15/11/2009.

Key inspection report Care homes for older people Name: Address: Willows Nursing Home Limited 10 Weld Road Southport Merseyside PR8 2AZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Lee     Date: 1 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 Limited 10 Weld Road Southport Merseyside PR8 2AZ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Gail Usherwood Type of registration: Number of places registered: care home 30 Willows Nursing Home Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing- Code N to people of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP The maximum number of people who can be accommodated is: 30 Date of last inspection Brief description of the care home The Willows is an older detached property that has been converted into a care home providing nursing care for thirty older persons. It is situated close to the sea front at Birkdale and is also within walking distance of Birkdale village. The home provides accommodation over three floors with lift access to all three. One bedroom situated on a mezzanine level floor has stair access and is used for residents with no mobility problems. There are twenty four single bedrooms and three double bedrooms. The communal day space consists of one large sitting room and a conservatory extension Care Homes for Older People Page 4 of 35 Over 65 30 0 Brief description of the care home attached. There is disabled access to the rear of the building and the garden can be accessed. There is a call bell system in the home. This service is presently operated by Mr & Mrs Jackson in partnership and trading as Jackson Care Group. Mr & Mrs Jackson have transferred the ownership to an existing Limited Company, which is registered as the provider of this service. The fee rate for accommodation is from £515.00 to £616.00 a week. 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: An unannounced visit took place as part of the inspection and this was carried out over one day for a duration of approximately nine hours. This was the first inspection of the home as Mr & Mrs Jackson have transferred the ownership to an existing Limited Company. The inspection was completed within the first six months of registration. Eighteen residents were accommodated at this time. The term resident is used in this report as this is what the people staying there like to be called. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with seven residents, one relative, four staff, the manager and the deputy manager. Mr and Mrs Jackson were present for the feedback to discuss the inspection. During the inspection three residents were case tracked (their files were looked at and Care Homes for Older People Page 6 of 35 they were asked for their views of the home). Other residents also took part in the inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. To find out more about the care provided at the home survey forms called Have your Say About..... were distributed to a number of staff and residents prior to the inspection. A number of comments included in the report are taken from the surveys received and talking with residents, relatives and staff. Five surveys were returned from the residents and six from the staff. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. Not all the information provided in the AQAA was evidenced at the time of the inspection. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: The following requirements have been made following the inspection. Serious concerns were raised in relation to meeting the health care needs of the residents. Care and support for residents must be recorded in an individual plan of care. There was no written evidence to support this in the three care files which were looked at. This shows a lack of understanding by the staff to promote the health care needs of the residents. Residents needs must be fully recorded in a plan of care to ensure person centred care is provided and that staff have the information they need to care for the residents safely. The lack of care documents does not enable staff to ensure the rights, preferences and wishes for the residents are taken into account. Risk management forms an important part of the residents care and risk assessments had not been completed for two residents. Risks to the residents must be assessed and staff given the information they need to ensure the residents safety and welfare at all times. Residents can administer their own medicines if they wish. The staff had not completed any risk assessment for this practice. This is required to ensure the resident can take care and administer their own medicines safely. There were no checks in place to monitor this. Three staff files were looked at to ensure recruitment practices were safe and that staff had an induction when they started and training to carry out their work safely. A new member of staff had not received an induction and the manager confirmed that staff require training in food hygiene. An induction must be given for all new staff so that they are aware of their job role, how to work safely and to provide the necessary care for the residents living at the home. Food hygiene training is required so that staff are confident they can handle food safely. Staff must be given fire prevention training so that they respond appropriately in the event of a fire to protect people in the home. A staff file was not available for inspection. Staff files must be made available for Care Homes for Older People Page 8 of 35 inspection to evidence safe staff recruitment procedures. The responsible individual/owner must undertaken monthly formal visits to the home and complete a report of his findings. As serious concerns have been raised in this report, the Regulation 26 reports must be forwarded to the Commission so that we can establish improvements to the management thus helping to protect people at the home. The management of the home must promote the health and welfare of people at the home. The requirements stated in this report must be addressed with urgency to ensure the ongoing protection of people who use it. The following good practice recommendations have been made to help improve the service offered to the residents. The staff have a formal assessment document and this should be used for recording resident care details prior to admission. One assessemnt see was not completed using this document and information regarding care needs was missing on another. The assessment should be dated and signed when written to ensure accuracy of the information recorded. It is strongly recommended that the staff complete their own assessment for all residents, as care needs may have changed since the social services assessment had been completed. Staff need to have up to date information to provide the necessary care and support to each person. Residents should sign a medicine agreement statement so that they understand the risks involved when administering their own medicines. It would be beneficial to keep a record of the foods residents like/dislike so that all staff are aware of what they enjoy. There was a complaints policy and procedure for the residents and their families to refer to should they wish to raise a concern. It would be beneficial to display a summary of the policy so that people can access this information easily. The document should have the necessary contact details for the Commission for referral. Staff should be offered courses in adult protection to safeguard people in their care. Contact details of the agencies involved with reporting an alleged incident and the whistle blowing policy should be displayed for staff to refer to. These measures will help to ensure staff are confident in how to report an alleged incident. There should be a plan of decoration or refurbishment for the building. This should include bedrooms as a number will require decoration in time to maintain a good standard of accommodation for the residents. Ceiling tiles in two bedrooms should be replaced as they had water stains and are not pleasant for the residents to look at. A number of small maintenance jobs had not been carried out and the manager should discuss the maintenance hours allocated to the home. This will ensure jobs are carried out promptly to keep the building in a good state of repair. Care staff should be encouraged to take on a key worker role. This gives staff responsibility for a number of residents and helps them to get to know the residents better and develop their own care role. Care Homes for Older People Page 9 of 35 The training records and plan were not all up to date to show the courses attended by the staff. This should show courses available to the staff and dates of renewal as part of their training development. Staff should be given the opportunity to attend regular supervision sessions to enable them to discuss care practices and their training needs. In light of the concerns raised in this report a review of the service should take place as soon as possible to ensure the service is managed in the residents best interest. 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 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information was provided to residents and their families to enable them to decide whether the service was right for them. Resident assessments could be formalised and be completed in more detail as there is a risk that not all residents needs are assessed in full. Evidence: Residents and their families had information regarding the service. The documents are called a Service User Guide and Statement of Purpose. They were displayed in the main hall for the residents to look at. The manager confirmed that they are also given to residents who wish to look round and see whether the home is right for them. The AQAA stated that residents and their families can visit the home prior to admission. A resident confirmed this and said how nice it was to meet the staff and to familiarise himself with the layout of the home. Likewise another resident said, The home is warm and welcoming. This helps to make the admission process for the Care Homes for Older People Page 12 of 35 Evidence: residents less daunting. The AQAA recorded that pre admission assessments are undertaken to ensure each residents physical and social needs can be fully met. To establish the information recorded for the initial assessment three resident care files were looked at. These showed that two residents had an assessment completed by the staff. Not all the information was dated and signed when completed. Formal assessment documentation was not used for one of the assessments and information was lacking regarding personal care, for example, the support needed with washing and dressing and whether a resident was at risk of falling. One resident had an assessment from social services. It is strongly recommended that the staff complete their own assessment as care needs may have changed for the resident and the staff need to have up to date information to provide the necessary care and support to each person. This will also help to ensure they can meet their needs in full. The assessment process should be reviewed to ensure it is more person centred and it should be completed using the formal documentation available at the home. It should also be signed and dated to ensure the information recorded is accurate. The manager stated that intermediate care was being provided at the home. This service is offered to residents for a short period of time. It is a means of providing respite care and also implementing a rehabilitation programme following discharge from hospital. This is instigated with the support of interemdiate care staff who attend the home and work with the staff to help the residents to become more independent. Intermediate care is discussed further under Standard 7 of this report. A member of the intermediate care team was visiting at the time of the inspection to help a resident with their exercise programme. A relative said they were pleased with the support from the intermediate care team. 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. Residents may be placed at risk as their health care needs were not promoted or well managed to ensure they received care according to individual need. Evidence: Residents had an individual care file and the AQAA recorded that residents are well looked after with all care received as per care plan. Case tracking took place of three residents to look at their care documents. The three care files seen did not evidence a plan of care. Residents needs must be fully recorded in a plan of care to ensure person centred care is provided and that staff have the information they need to care for the residents safely. An up to date plan of care had not been completed by the staff to support the intermediate care being given to a resident. Risk management forms an important part of the residents care. This was lacking in two care files seen. Where a risk has been identified this must be recorded in conjunction with the plan of care and the staff be provided with information as to the nature of the risk and how it can be minimised. This help to keep the resident safe and promote their general welfare. There was a lack of risk management in a number of Care Homes for Older People Page 14 of 35 Evidence: areas relevant to the residents who were case tracked. For example, moving the resident safely and assessing the risk of falling, ensuring residents received a good diet, monitoring any weight gain or loss and care of their skin which may be at risk due to frail health. Risk assessments were not in place for residents who are able to leave the home unescorted. The promotion of this independence is important however to ensure the safety of the residents a risk assessment must be completed so that the staff are confident the resident will be safe and that the resident understands the risks involved. The staff had completed daily care records. There was evidence to show that residents had appointments with health professionals, for example, their own GP or hospital appointment to keep them well. Without a plan of care however it was difficult to establish their individual care needs, level of support needed and how decisions have been reached to monitor their health. During the inspection a resident needed some medical assistance and this was arranged promtly by the staff. Talking with residents and information received from the surveys showed that the staff offered good support to the residents in different aspects of daily living. For example, help with washing and dressing, socialising and promoting independence. A resident commented on how attentive the staff were when helping. The manager had a contract with a local pharmacist for supply medicines to the home. A number of medicine charts were looked at and these showed that staff had signed for medicines given. The manager completes a monthly check of medicine administered to ensure they have been administered correctly. An audit for this was seen and a check of a number of medicines undertaken at the time for the inspection confirmed correct balances for them. Advice was given on recording prescribed food supplement drinks, as these had not always been signed on the medicine charts. Residents interviewed said they received their medicines on time. With regards to residents administering their own medicines there was a concern regarding the lack of risk management for this. There was no risk assessment in place for a resident who wished to take care of their own medicines. This is required to ensure they are aware of the risks involved and that they can take them safely. Residents should sign an agreement statement so that they understand the risks involved when administering their own medicines. Although the staff promote independence for residents to manage their own medicines, the current practice may put people at risk as it it not checked and monitored effectively. Care Homes for Older People Page 15 of 35 Evidence: Feedback from the residents and relatives was good in relation to staff attitude. They referred to the staff as being polite and helpful in their approach. Staff were seen to talk with residents in a quiet reassuring manner and they explained what they were going to do when helping them. For example, helping them to walk with different aids and also choosing meals. A resident said, The staff are very pleasant indeed. Staff were seen to knock on bedroom doors before entering as a mark of respect. Staff interviewed discussed in good detail the care care needs of the residents however the lack of written evidence undermined the care and support they were providing. The residents privacy and dignity may be compromised, as individual preferences, wishes and choice had not been recorded in any plan of care. Residents and their families should be consulted with regard to the care they receiving to ensure they fully understand the level of support they need to keep them well. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents could choose how to spend their day and were able to join in with different activities. Residents were offfered a good choice of foods so that they received well balanced meals. Evidence: Residents interviewed said they were happy with the routine in the home and that they could choose how to spend their day. The AQAA refers to residents being encouraged to maintain their own lifestyle and as previously stated under Standard 7, individual preferences should be stated in the plan of care. For example, time of getting up, retiring at night, preferred foods and family involvement. This provides information needed for person centred care. At the time of the inspection a number of residents were sitting in the lounge or conservatory. Some had chosen to remain in their private room or were enjoying the sunshine in the garden. A resident commented on the freedom offered to him by the home and how he enjoyed going out each day. Visitors were present at different times and they were able to meet their family member in private or sit in the lounge, conservatory or garden. A relative said they Care Homes for Older People Page 17 of 35 Evidence: were alway made very welcome and offered refreshments. The AQAA reported the need to provider greater emphasis on the social aspect of the care of the residents. The manager is in the process of introducing a more structured record for resident activities. This should continue to evidence resident particiaption and enjoyment. The AQAA recorded that a member of staff has completed a course on the importance of activities and mental stimulation which should help to ensure creativity for social arrangements. The staff care for a number of residents who are frail in health however they are offered activities on a one to one basis. Musical entertainment, quizes and an exercise class are provided in the lounge for everyone to join in. These were advertisd in the main hall for residents to see. The group of homes own a minibus and outings should be arranged for the residents as a number expresssed an interest in going out on excursions. The managed said this would be looked into. The hairdresser was visiting at the time of the inspection and Holy Communion is offered by visiting clergy to enable resident to continue with their chosen faith. The AQAA recorded that residents are enocuraged with a good diet to promote thier health. This was found to be the case. Residents interviewed were pleased with the standard of the meals served. The menu was based over four weeks and offered residents plenty of fresh fruit and vegetales. The daily choice was displayed at the time of the inseption and residents interviewed said they were asked what they would like to eat. They also said that the cook was very willing to cook anything they fancied. Although the cook was aware of the residents likes and dislikes it would be benefical to keep a record of preferred meals in the kitchen so that staff also have this information when the cook is not on duty. It was a warm day and residents were offfered plenty of drinks to ensure their comfort. A staff member stated meal times were too close together. Residents did not raise this as a concern. The majority of residents had their meals served on trays however they can use the dining room tables if preferred. Comments regarding the food included, Brilliant, Very good indeed and It could not be nicer. Care files looked at showed a lack of dietary requirements and this was discussed in relation to a special diet required for a resdient. This detail must be recorded in the plan of care to ensure their nutritional needs are met. The requirement for this is stated under Standard 7 of this report. Care Homes for Older People Page 18 of 35 Evidence: A recent environmental health insepction reported favourably regarding the standard of cleaniliness in the kitchen and records seen at the time of the insepction were up to date for checking food temperatures. Food stocks were plentiful and this included lots of fresh fruit and vegetables. Local advocacy details were displayed in the home so that residents can contact an advocate if they wish to seek independent advice. Care Homes for Older People Page 19 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. Safeguarding measures could be improved to ensure staff know how to protect people. Evidence: There was a complaint policy and procedure available for residents and their families.It would be benefical to display a summary of the policy so that people can access this information easily. The document should have the necesasry contact details for the Commission for referral. Residents interviewed said they were happy with current arrangements in the home and that they would speak to the staff if they had a concern. A relative reported, If I have any complaints they are dealt with. The AQAA reported that two complaints had been received and one upheld following an investigation. The Commission has not received any complaints. Staff had received training in protecting people to safeguard their welfare. Discussion with the manager and looking at staff records confirmed that a number of staff had not had this training since 2007 whilst others had attended a training session this year. It is incorporated in the induction for new staff. This training should be arranged regularly to ensure all staff are aware of the local procedures to be followed should they witness an alleged incident. Staff interviewed were able to describe what abuse is, however they were unsure of contact details of the agencies and who carries out the investigation. These contact details and the whistle blowing policy should be displayed so that staff are confident in how to report an incident. Care Homes for Older People Page 20 of 35 Evidence: The AQAA recorded one safeguarding referral and this was reported to the safeguarding team. The Commission were involved with this referral and one element of the incident was upheld following a full investigation. The manger has put measures in place to minimise this happening again. Records had been seen at a formal meeting in relation to the referral however there was no formal log of the corespondence relating to the incident. The manager was advised that a formal record should be maintained of all the correspondence. The AQAA reported that the manager has undertaken training on the Mental Capacity Act and safeguards in place to protect people who may lack capacity to make a decision. This training should be cascaded to all staff as part of their formal development. Care Homes for Older People Page 21 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. Residents live in safe, clean, maintained accommodation. Evidence: Residents interviewed said they liked their accommodation and that it was kept clean and nicely decorated. The manager said that maintenance hours for the home were not sufficient and the maintenance book showed that jobs needed doing from May 2009. Maintenannce hours allocated to the home should be sufficient to ensure maintenance work is carried out promtly. This will help to keep the home in a good state of repair. This was brought to the managers attention to disuss with the owners. There was no plan of decoration or refurbishment for the building and this would be benefical as a number of bedrooms will need decorating in time due to general wear and tear. The AQAA reports the need for for a set budget for decoration and soft furnishings and staff reported that the home would benefit from modernising, for example, painting and decorating. Bedrooms seen had a call bell for residents to ring when needing assistance and a number had lockable drawers to store belongings safely. A small number of rooms had new carpets and furniture and this should be provided in all bedrooms over a period of time. This would help to improve their appearance. Ceiling tiles were stained in two bedrooms and they should be replaced to improve the accommodation. The bedrooms Care Homes for Older People Page 22 of 35 Evidence: were identified with the manager at the time of the inspection. Residents who needed to rest in bed due to frail health had the use of special beds to ensure their comfort. A double room is currently being used as a single room to provide extra space for the resident. Bathrooms were clean and there were no unpleasant smells. Residents had the use of equipment to help them bathe safely. This included a walk in shower and also a specially adapted bath to help residents get in and out safely. The AQAA reported that hot water to the baths is tested to ensure it is at a safe temperature for the residents. Other aids to promote resident independence inlcuded hand rails and raised WC seats. Staff interviewed said they had plenty of equipment to enable them to carry out their duties safely. The ground floor has a lounge and conservatory. The conservatory has access to the garden for wheelchairs. Residents had the use of comfortable armchairs and coffee tables. A large screen TV provides easy viewing for the residents in the lounge. The laundry room was organised and residents said their clothes were returned promptly. The manager has signed up to local infection control procedures to ensure good standards of cleanliness are promoted. There were gloves, aprons, liquid soap, hand gel and paper towels available to ensure good standards of hygiene. A domestic washing machine is curerntly being used whilst the staff wait for a new industrial machine to be delivered. The rear garden was landscaped and had patio furniture and sun umbrellas. Residents were sitting outside and enjoying the sunhsine. The manager would like a raised flower bed so that residents can enjoy gardening in comfort. Care Homes for Older People Page 23 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. A lack of staff induction and training could place residents at risk. Evidence: The staffing rota showed the number of staff on duty to care for the residents. The AQAA reported that staffing levels reflect residents needs. Staffing numbers have been decreased as there are currently only eighteen residents accommodated. Staff reported that the home can be busy and sometimes they do not have time to do extra things for the residents. Staffing levels should take into consideration the time spent with each resident and it would be benefical to have evidence of the formal tool used to establish the staff to resident ratio. At the time of the inspection the manager was on duty with four care staff, a cook, two domestics and laundry assistant. The deputy manager arrivied late morning, this was pre-aranged to help with administrative work. Staff interviewed were able to discuss different aspects of the residents care. They were chatty with the residents and displayed a genuine interest in their welfare. Care staff should be encouraged to take on a key worker role. This gives staff responsbility for a number of residents and helps them to get to know the residents better and develop their own care role. Residents interviewed said they were pleased with the care they received and that they felt the staff did their best. Their comments included, The staff give me lots of Care Homes for Older People Page 24 of 35 Evidence: help, I ring the bell and they come when they can and I am well looked after and very pleased with the home. Likewise relatives said, I find the staff caring and helpful and Every possible care is given and always given with kindness. The home was found to be clean and tidy and residents confirmed that their bedrooms are cleaned most days. The AQAA reported that eleven out of eighteen staff have achieved an NVQ (National Vocational Qualification) in Care at Level 2 or 3 which is above the 50 required to evidence formal training in care. Staff spoken with said they were undertaking NVQ studies and certificates were seen in some training files. Four staff files were looked at to ensure staff had been recruited safely. This included the staff files for two new staff, one staff file could not be located. The requirement for this is stated under Standard 37 of this report for record keeping. Staff files seen showed that police checks and references had been sought prior to a staff member starting work. Some references were not dated and the manager was advised that they should be to ensure accuracy of the information received. The AQAA recorded that induction training for all grades of staff is provided by an outside company. This was found not to be the case. One new staff member had no written induction on file. An induction must be given for all new staff so that they are aware of their job role, how to work safely and to provide the necessary care for the residents living at the home. The AQAA gave insufficient information regarding staff training. The training plan and training files seen were not up to date with current courses attended by staff and not all staff training files were available. It was difficult to establish the level of training offered to the staff through the records. The training plan should show courses available to the staff and dates of renewal as part of their training development. An external trainer is used for providing training to the staff in safe working topics such as, first aid, infection control and abuse. Moving and handling trainer is given by a trainer from one of the other homes owned by Mr and Mrs Jackson. The manager was unsure of food hygiene courses and no dates were provided for this on the training plan. The manager confiremd that this was needed by a number of staff. Staff require this training to ensure they handle food safely. Other courses offered to staff included diabetes, continence management and person centred care. Care Homes for Older People Page 25 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. The home was not being run in the best interests of the residents and their welfare is not promoted and protected. Evidence: The manager is registered nurse and holds the necessaary NVQ mangement qualifcations to manage a care home. The manager stated that she needs to attend a number of courses in safe working which she will undertake with the staff. Feedback from surveys received and interviews with staff confirmed that the manager was approachable and that you could talk to her any time. The staffing rota showed that the manager has some supermumerary hours for the completion of managerial duties. In light of the requirements raised in this report disussion needs to be held with the owners regarding more supernumerary time for the manager to improve the recording of care needs for the residents. Records for the service seen at the time of the inspection did not evidence all the information stated in the various sections of the AQAA. This was discussed with the Care Homes for Older People Page 26 of 35 Evidence: manager, as the AQAA must give an accurate picture of the home. The management of the service must be improved as the lack of care plans and supporting documents places resident at risk . A review of the service would be benefical to ensure it is being run in the best interets of people accommodated. The staff have been awarded an external quality award and residents and relatives were given surveys to complete at that time to enable them to expresss an opinion about what the home does well and how it could be improved. Feedback from the surveys included a request for a hot and cold drinks facility for the relatives and this has been arranged. There was no evidence to support the fact that staff attend meetings or meetings are held with the owners or other managers with the group of homes. Regular meeting should be held so that staff can discuss the home and any concerns they have. A resident meeting was held in February 2009. As a number of residents are frail and the manager said meetings are not well attended. A staff file was not available to check the recruitment of the employee. Staff records must be made available for inspection to ensure the protection of the residents. There was no evidence to show that the responsible individual/owner completes a monthly Regulation 26 report. This is completed following a visit to the home, which enables the owner to meet with staff, residents and to check and monitor the standard of the service provided. The visits were stated as being undertaken in the AQAA. Regulation 26 visits must be conducted each month and a copy of the reports forwarded to the Commision. This is required as residents are currently placed at risk by the care planning practices. The manager said that no monies are held on behalf of the resdients. Assistance would be given if this was required and staff had policy documents to follow to ensure residents financial interests were protected. Staff interviewed said they had received supervision. Records seen showed that this had not been given recently to staff. Staff should be given the opportunity to attend regular supervision sessions to discuss care practices and training needs. This helps the staff with the development of their job role. Health and safety policies and procedures were in place. Details of these and contract details for equipment and services were evidenced in the AQAA. A spot check of the Care Homes for Older People Page 27 of 35 Evidence: gas, electric, hoisting equipment and fire protection contract showed they were in date. This helps to protect people who use the service. There was a fire risk assessment of the building and fire alarms and emergency lighting were subject to regular tests in the home. A number of staff require fire training as this has not been given since 2007. This must be arranged with urgency so that staff are aware of the fire procedures to be followed. Accident reports were on file for the residents and action taken by the staff recorded in the daily care notes. Without a plan of care or risk assessment it was difficult to assess whether there was an increase in risk to the resident and how the staff could provide extra support. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 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 7 15 The health and personal care of the resident must be recorded in a plan of care. This will ensure staff are aware of their current needs and will provide the necessary care and support needed. 11/08/2009 2 8 12 Risks to the residents must be identified in their plan of care. This will promote their health and well being and minimise the risk of injury to them 11/08/2009 3 9 13 A risk assessment must be 11/08/2009 completed for residents who wish to administer their own medicines. This will ensure residents are able to undertake this safely and are aware of the risks involved. Care Homes for Older People Page 30 of 35 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 4 30 18 Staff require training in food hygiene. This will ensure they have the skills and knowledge to handle food safely. 08/09/2009 5 30 18 New staff must have an 11/08/2009 induction when they commence employment. A written form of induction is required to ensure staff so that they are aware of their job role, how to work safely and to care for the resident group. The management of the 11/08/2009 home must promote the health and welfare of people at the home. This will ensure they receive the care and support they need for their ongoing welfare. 6 32 12 7 33 26 Regulation 26 visits must be undertaken by the responsible individual and a report written of their findings. A copy of the reports must be forwarded to the Commission. To demonstrate that the quality of the service is being checked and monitored. 11/08/2009 Care Homes for Older People Page 31 of 35 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 8 37 17 Staff files must be available for inspection. This will ensure recruitment practices are safe to protect people in the home. 11/08/2009 9 38 23 Fire training must be given to the staff. This will ensure they they respond appropriately in the event of a fire to protect people in the home. 11/08/2009 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 3 The homes formal assessment should be used for recording all resident care details prior to admission. The assessment should be dated and signed when written to ensure accuracy of the informatin recorded. It is strongly recommended that the staff complete their own assessment as care needs may have changed for the resident following the external professional assessment. The assessment should also be completed in sufficient detail so that the staff have up to date information to provide the necessary care and support to each person. Residents and their families should be consulted with regard to the care they receiving to ensure they fully understand the level of support they need to keep them well. Residents should sign an agreement statement so that they are understand the risks involved when administering their own medicines. Residents preferred foods should be recorded so that all staff are aware of what the residents like to eat. 2 7 3 9 4 15 Care Homes for Older People Page 32 of 35 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 5 16 There was a complaint policy and procedure available for residents and their families. It would be benefical to display a summary of the policy so that people can access this information easily. The document should have the necesasry contact details for the Commission for referral. Staff should be offered courses in safeguarding people. Contact details of the agencies involved with reporting an alleged incident and the whisteblowing policy should be displayed. These measures will help to ensure staff are confident in how to report an incident. Maintenannce hours allocated to the home should be sufficient to ensure maintenance work is carried out promtly. This will help to keep the home in a good state of repair. A plan of decoration or refurbishment for the building should be implemented. This should include bedrooms so that the residents accomodation is maintained to a good standard. The ceiling tiles in the bedrooms identified with the manager should be replaced to improve the accomodation for the residents. 6 18 7 19 8 27 Care staff should be encouraged to take on a key worker role. This gives staff responsbility for a number of residents and helps them to get to know the residents better and develop their own care role. Staff references should be dated to ensure accuracy of the information received. The training records and plan were not all up to date to show the courses attended by the staff. This should show courses available to the staff and dates of renewal as part of their training development. A review of the service should take place as soon as possible to ensure the service is managed in the residents best interets. This should include meetings with staff, the residents and the owners and sending out satisfaction surveys to gain residents views. A review of the managers 9 10 29 30 11 33 Care Homes for Older People Page 33 of 35 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 supernermary hours would also be beneficial to assisst with the completion of managerials tasks. 12 33 The quality of the service provided to the residents should be reviewed in light of the concerns raised in this report. Staff, resident and meetings with the owners should be held regularly so that people can voice their opinions of the service. Willows must be run in the best interests of the people who use it. Staff should be given the opportunity to attend regualar supervision sessions to enable them to discuss care practices and their training needs. 13 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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