Inspection on 10/09/08 for Willows (The)

This inspection was carried out on 10th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willows (The) 08/10/07

Willows (The) 18/04/06

Willows (The) 21/10/05

Willows (The) 29/06/05

Willows (The) 20/10/04

Willows (The) 30/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2008.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Willows (The) The Old Grove High Pitfold Hindhead Surrey GU26 6BN     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: Kenneth Dunn     Date: 1 0 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Willows (The) The Old Grove High Pitfold Hindhead Surrey GU26 6BN 01428 609851 Telephone number: Fax number: Email address: Provider web address: willows@robinia.co.uk Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Robinia Care South Limited Ms Sharron Ann Blackman care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability sensory impairment Additional conditions: Of the ten (10) service users in category LD (Learning Disabilities), two (2) may also fall within the category SI (Sensory Impairment) Of the ten (10) service users in category LD (Learning Disabilities), two (2) may also fall within the category SI (Sensory Impairment) The age/age range of the persons to be accommodated will be: 18-50 YEARS 10 2 Over 65 0 0 Date of last inspection Brief description of the care home Robinia Care Ltd provides a range of residential and day services for people with disabilities on the Old Grove Site at High Pitfold Hindhead. The Willows is a detached bungalow that offers long term residential care for up to 10 adults aged between 19 and 50, with learning disabilities who require a high level of support. The care home has 10 single rooms, three bathrooms and a shower room. The home can be viewed as having two units each providing support for five service users whose rooms are Care Homes for Adults (18-65 years) Page 4 of 29 situated in each unit. Each unit has large lounge/dining rooms, although kitchen and laundry facilities are shared. Although designed as two units service users were able to access all areas of the home. Service users have ready access to the immediate grounds, which consists primarily of a hard surface area. Weekly care costs #1846.15 Care Homes for Adults (18-65 years) Page 5 of 29 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 Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. The inspection of this Care Home for Younger Adults was an unannounced Key Inspection. The inspector looked at how well the service is doing in respect to the National Minimum Standards for Care Home for Younger Adults. The site visit took into account detailed information provided by the registered provider and the manager, and any information that Commission for Social Care Inspection has received about the service since the last inspection. The inspector looked at how well the service was meeting the standards set by the Care Homes for Adults (18-65 years) Page 6 of 29 government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the care plans, daily records and risk assessments, medication procedures. The service has submitted the Annual Quality Assurance Assessment prior to the inspection, some details of which have been added to the report. No complainant has contacted the Commission for Social Care Inspection with information concerning a complaint made to the service since the last inspection. From the evidence seen by the inspector and comments received, the inspector considers that the agency would be able to provide a service to meet the requirements of individuals who have diverse religious, racial or cultural needs. The inspector would like to thank the people who use the service and the staff for their time, assistance and hospitality during this inspection. The quality rating for this service is 1 star. This means the people who use this service experience an adequate quality outcome What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The people who use this service have access to a range of information to enable them or their Representatives to make an informed decision on whether the service is able to meet their specific needs. Detailed assessments are undertaken prior to any person being offered a service. Evidence: A review of the statement of purpose and service users guide was undertaken as part of this site visit. The review demonstrated that there is a range of detailed information available to the people who use the service to allow them or their representatives to make an informed decision on whether the service is able to meet their specific needs. There is evidence that the statement of purpose has been reviewed and updated, however recommended that the registered manager adds to the date of the current addition was introduced and the date it was reviewed. There has been no new service users since the last inspection visit (08/10/2007). A random sample of the individual files of the people who use the service was Care Homes for Adults (18-65 years) Page 10 of 29 conducted, and in all cases there had been detailed needs assessment completed for the individuals concerned. The assessments were detailed and contained relevant information to enable the service to design a care plan for each individual. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. The people who use this service are provided with an individual care plan, which records their individual needs and goals. They are supported to make decisions about their lives with assistance. Individuals are supported by staff. Evidence: A member of staff stated that because of the complex needs of the residents it would be impossible for the residents to be enabled to have appropriate control over their lives, however the staff offer appropriate levels of support. It was stated that the support offered is to promote some form of individual independence no matter how small. Individual needs and personal goals of residents were clearly recorded and these have been carefully developed using the residents previous likes and dislikes. Care Homes for Adults (18-65 years) Page 12 of 29 The service also consults with families and other stake holders/professionals. The sample indicated that review meetings have taken place for all of the residents with the full involvement of all relevant parties. Health action planning had taken place for all of the residents and was clearly reflected in the care documentation. The Comments received by professionals who visit the home regularly indicated a high level of satisfaction with service provision at The Willows. A good practises recommendation was made for the service to audit the residents files to ensure that they are uniform in appearance and user friendly. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Individuals are able to exercise appropriate levels of choice in their daily lives. Staff assist the residents to maintain bonds with family and friends, and take part in social, cultural, religious and recreational activities. The meals provide are healthy and balanced but very limited. Evidence: Individualised activities programme are available to people living in the home meeting their personal preferences, aspirations and goals in life. Throughout the inspection of the home the residents were engaged with a variety of activities which included individuals going out with staff to day care facilities listening to music and watching Care Homes for Adults (18-65 years) Page 14 of 29 TV. A member of staff stated that they are flexible in promoting individuals to choose the level of activities they attend. The Annual Quality Assurance Assessment stated all individuals at the home attended a day centre where they participate in activities. A sample of daily notes demonstrated that individuals are encouraged to participate in at home activities around the home. The people who use the service benefits from this use of dedicated vehicles in order to access the local communities for outings and trips. There is well documented evidence that family members are always welcome, and that there are no restrictions on when people can visit the home and that everyone has his own rooms to entertain visitors. The homes policy is to ask all visitors to sign the visitors book. Staff endeavour to promote the independence of the people who use the service by offering them individual support in whatever they are doing. The ethos is to promote support rather than doing for somebody. The people who use the service are respected and the staff ensure that they are offered privacy treated with dignity when being supported in their personal care. The AQAA provide evidence that all members of staff have undertaken training in diversity and respect, this was reaffirmed on the day of the site visit by a member of staff. It was stated that the service had arranged for all staff members to participate in training for diversity awareness, privacy and respect. This was not corroborated during the visit as the staff members on duty have no access to files. The inspector was informed that only the manager holds the keys to the files private and confidential staff files. A requirement has been made regarding access to information please refer to the staffing section of this report. The service has only one basic menu, for 7 days, which could mean very repetitive meals. It would appear that the same choices of meals are provided on the same day every week for example Mondays lunch could be sandwiches and dinner pizza, there was no variation. A member of staff however stated that meals are flexible and can be changed very easily depending on the weather or the needs of the residents. It is essential that the manager undertakes a review of the menus to ensure that they offer a balanced diet and to record any variation whenever they occur. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has consistent recording and documentation to evidence that the people who use the service, health care, wellbeing and welfare are supported. The homes medication procedures are robust to ensure the safety of the people living in the home. Evidence: The care plans demonstrated that the personal support needs were well documented and had been agreed with the resident, families and health care professionals. A member of staff stated that the time for getting up and going to bed in the home is flexible. A review of individual care plan indicated that all residents are registered with a local general practitioner (GP). It was documented that the people who use the service have access to dentists, Care Homes for Adults (18-65 years) Page 16 of 29 chiropodists and opticians. A member of staff stated that good observation of the residents helps in the quick identification of the changing needs of the individuals, this enables us to request specialist in-put for their assessments. All medication is stored in a locked cupboard and there is documentation to indicate that the medication is reviewed and audited regularly. The homes Medication administration practises were examined. Protocols were in place for service users receiving As required medication. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The people who use this service benefit from a robust set of policies and procedures designed to protect and safeguard them from abuse. Evidence: The complaint procedure had been produced in a pictorial format. Records sampled indicated that there have been no complaints made since the last inspection. The Commission for Social Care Inspection have not been informed of any issue or complaint since the previous inspection visit 08/10/2007. There is a clearly written safeguarding adults procedure and a copy of the local authority safeguarding adults from abuse policy was available. The contact details for the local authority Social Care Team was also displayed. The AQAA provide evidence that all members of staff have undertaken safeguarding training, this was reaffirmed on the day of the site visit by a member of staff. This was not corroborated during the visit as the staff members on duty have no access to files. The inspector was informed that only the manager holds the keys to the files private and confidential staff files. A requirement has been made regarding access to information please refer to the staffing section of this report. Care Homes for Adults (18-65 years) Page 18 of 29 Care Homes for Adults (18-65 years) Page 19 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 layout of the home should enable the people who use the service to live in a safe environment. The home is clean and hygienic. Evidence: A full tour of the building was undertaken as part of the site visit. The home is purpose built low level building and designed to be fully accessible to the people who use the service. The home is one of several care homes and services on site operated by Robinia Care. On the day of the visit the home was cold, a number of windows and doors were open for ventilation. A member of staff stated that the heating was not set by the home, the responsibility for the heating was the main site management and they decided when the heating should be set. The home has two sitting rooms in both the decor was adequate, however the furniture and fittings in sitting room to the right of the building was poor. The curtains were hanging down away from the walls, in addition the chairs and couches were damaged and the fabric ripped. The single toilet adjacent to the right hand sitting room was not working, a member of Care Homes for Adults (18-65 years) Page 20 of 29 staff stated that this had been reported but had not yet been attended to. An immediate requirement was made regarding exposed nail heads sticking out of a bedroom door (approximately 100mm). A member of staff made arrangements for these nails to be removed and this was actioned before the end of the visit. The carpets throughout the service were stained and one of the joins in the main corridor had become unstable. Over all the service was clean, however one bedroom had a very strong smell of urine. Care Homes for Adults (18-65 years) Page 21 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 staff group appeared skilled and in sufficient numbers to provide 24-hour care within the home. The systems for recruitment and training are designed to be robust and should protect the people who use the service. Evidence: The completed AQAA stated that all staff currently working at the home have undertaken a full induction programme. The staff on duty confirmed that they have completed an induction programme. As was previously stated in this report the records were not available to confirm this. The inspector was provided with copies of duty rotas, which indicated that adequate staffing levels are maintained in the service. The organisation has a robust set of recruitment policies and procedures. The policies require potential staff members producing all the relevant documents as detailed in Schedule 2 of The Care Homes Regulations 2001 are requested prior to starting in the Care Homes for Adults (18-65 years) Page 22 of 29 service. The AQAA states that all staff has had a criminal record bureau (CRB) check and Protection of Vulnerable Adult (POVA) check prior to starting work in the home. As was previously stated in this report the records were not available to confirm this. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 people who use the service should benefit from home that is well run. There are procedures in place to self-monitor the services being offered. The health, safety and welfare of individual within the home are promoted and there are appropriate risk assessments in place Evidence: The manager provides management stability, leadership and direction to the staff team. Further evidence reviewed during the site visit confirmed the home had a management structure with clear lines of communication and accountability and during discussions a member of staff stated ‘the manager is making changes for the better. The home had a policy on quality assurance and used questionnaires to obtain Care Homes for Adults (18-65 years) Page 24 of 29 feedback about the home from relatives and stakeholders. A review of records confirmed a survey was carried out on the 12th March 2008 and the findings were available at the home for information. One care manger stated that the service and the staff team are very supportive in a way that reduces individuals anxieties and another health care professional stated that the residents are supported in a very consistent way. Further evidence indicated the provider carried out regular Regulation 26 (monitoring visits) with appropriate management action taken to safeguard the welfare of the home. The home had a policy on health and safety and staff stated that they have received training in health and safety, fire safety, basic food hygiene and first aid. As was previously stated in this report the records were not available to confirm this. The AQAA stated that the home has a current gas safety certificate and service inspection reports for fire equipment, small portable appliances and emergency lighting. This was confirmed by a member of staff however the certificates could not be located at the time of the site visit. The home had information about health and safety displayed in the home and a policy on COSHH (Control of Substances Hazardous to Health) to promote safety. Care Homes for Adults (18-65 years) Page 25 of 29 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 Adults (18-65 years) Page 26 of 29 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 1 24 23 The exposed nail heads sticking out of the identified bedroom door, must be removed to ensure the residents are safe from harm. The home must be of sound state of repair. 17/09/2008 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 24 16 The registered provider must undertake an audit of furniture, carpets and curtains to ensure that they are fit for purpose. To ensure that the residents live in homely environment. 10/10/2008 2 41 17 The registered provider must ensure that all records are fully available for the purpose of the inspection process. The interests of the residents must be safeguarded by the homes record keeping. The CSCI must have access to these records. 10/10/2008 Care Homes for Adults (18-65 years) Page 27 of 29 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 14 15 16 1 6 17 The registered manager should ensure that documents are dated and reviewed regularly. The service to audit the residents files to ensure that they are uniform in appearance and user friendly. The register manager should undertake a full review of the system of meals at the home. The menus should demonstrate wholesome and nutritious meals provided for the residents. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!