Inspection on 26/05/06 for Withy Grove Care Home

This inspection was carried out on 26th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Withy Grove Care Home 29/09/08

Withy Grove Care Home 29/07/08

Withy Grove Care Home 08/08/07

Withy Grove Care Home 28/11/06

Withy Grove Care Home 22/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Withy Grove Care Home Withy Grove House Off Poplar Grove Bamber Bridge Preston Lancashire PR5 6RE Lead Inspector Mrs Marie Dickinson Key Unannounced Inspection 11:00 26 May, 1 and 6th June 2006 th st X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Withy Grove Care Home Address Withy Grove House Off Poplar Grove Bamber Bridge Preston Lancashire PR5 6RE 01772 337105 01772 620158 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne (Eton) Limited Care Home 54 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (30) of places Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 54 service users to include: Up to 24 service users in the category of DE - (Dementia). Up to 30 service users in the category of OP - (Old Age, not falling within any other category). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 22nd November 2005 2. 3. Date of last inspection Brief Description of the Service: Withy Grove House is a residential care home providing 24-hour personal care and accommodation for 30 older people who have care needs and 24 older people who have care needs associated with dementia. The proprietors of Withy Grove House are Ashbourne (Eton) Limited. Withy Grove House is a converted Manor House, which is set in its own landscaped gardens adjacent to parkland. The home is in a predominantly residential area, but within easy walking distance of Bamber Bridge centre. Bus and train services can be accessed to larger towns, such as Preston, Chorley and Blackburn. Bedroom accommodation is on the ground and first floors. All bedrooms are used for single accommodation and 29 have en-suite facilities. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. There are sitting and dining areas sited on both floors and across the car park from the home is a private lawn area where residents are able to enjoy activities, weather permitting. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 26th May 1st and 6th June 2006. The inspection involved getting information from staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager and visitors, and included a tour of the premises. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well: What has improved since the last inspection? The pre-admission process includes written confirmation of whether or not a residential place can be offered. Employment practices had improved. Staff were issued with a contract so that terms and conditions of employment were known, understood and agreed. To reduce the potential for unnecessary restraint or physical injury risk assessments relating to bed rails had been carried out involving the resident, their representatives and district nursing services. Kitchen cleaning schedules and the maintenance action plan were being completed. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 6 Policies and procedures had been reviewed and staff were being given guidance in understanding their role and responsibility to follow these. Training relating to care of the dying was provided for staff to develop skills and knowledge in this area. What they could do better: To make sure residents receive the right care, assessment of needs must be kept under review. This must include physical, social and health care needs. By assessing needs regularly, changes in individual circumstances can be dealt with promptly and essential support provided by staff. Monitoring resident’s healthcare must improve and when supporting resident’s healthcare, advice and treatment prescribed for residents must be followed in a timely manner. Medication management requires improvement. Continence care must be also be managed better to help people maintain their dignity. Nutritional needs of residents must be monitored. The residents accommodated in the dementia unit should be offered a varied selection of food and improvements made in how it is served. To prevent injury and maintain the dignity of residents in the dementia unit residents should not be without suitable footwear. Residents must be provided with a sufficient range of suitable activities that would meet their needs and expectations. People visiting the home should feel comfortable speaking to staff. The complaints procedure must be promoted better and all issues people bring to the attention of staff and management must be taken seriously. To make sure residents are protected from abuse management must respond promptly to any allegation made. Accommodation and facilities need to improve. This included general maintenance of the driveway, safer access to the garden areas by removing built up debris and the gardens maintained to a better standard. This was also a suggestion made by a relative in a comment sent directly to the Commission ‘to improve the garden areas’. Residents must always be consulted in proposed changes to avoid dissatisfaction, as they were clearly unhappy about changes to the garden area regarding filling in the fishpond. Improvements were required in the dementia unit to improve the general standard of accommodation. This included making sure adjoining doors to rooms are kept locked and consideration given to the possible confusion residents with dementia may have with these doors. To help residents find their rooms clear signs should be used with their names on. Bedroom doors should be kept locked where needed and staff should take into account family wishes regarding this issue. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 7 Some bedrooms required decorating and suitable furniture provided. Some bedroom floor coverings required replacing. Lighting in the unit requires improvement, as the corridors were dull and did not give a good atmosphere for residents. The heating required better control and guidelines for a possible heat wave should be available for reference. The home must be kept tidy of unused items. To keep the home from smelling unpleasant, cleaning arrangements must be improved and sufficient staff employed for this purpose. Designated smoking areas must be provided so that non smokers comfort is maintained. Laundry facilities must be kept clean and organised with better care given to resident’s personal clothing and footwear. The kitchen also required some general maintenance. Sufficient staff must be employed to make sure that resident’s care is given to a satisfactory standard and the numbers of staff on duty be effectively maintained. This is a concern of a number of relatives who gave several comments including commented ‘how can two care assistants plus a senior (not always available) tend to the caring duties’ and sometimes difficult to find staff. Training of staff must include first aid. The manager must improve on all standards identified in this report. Better partnerships must be made between the members of the home and management structure to enable improved communication and change processes to be implemented. The views of relatives must be considered and professional relationships with staff, residents and others be promoted. Staff should have regular supervision and as good practice be given a return to work interview following absences due to sickness Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. People were given enough details about of the home’s services and facilities to help them make a decision to stay at the home. Assessments of people wanting to live in the home contained enough information to plan how care needs were to be met. Trial stays were offered. EVIDENCE: Four people who returned a completed questionairre to the Commission said they had received enough information before they were admitted that helped them decide if the home was right for them. The service user guide given to people provided sufficient information about the home. Since the last inspection the manager said all new residents have their placement at the home confirmed in writing. Residents were given contracts. The pre-admission assessment format was thorough and covered all aspects of personal, health and social care needs. Assessment of care needs had been completed for new residents. This included in most instances both social care assessment and a homes assessment. These contained sufficient detail to Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 10 identify if the home was suitable. Information essential to provide the right care was recorded and from these assessments an individual plan of care was written and agreed with everyone concerned. It was the homes policy that before anyone is admitted they are given an opportunity to visit and look at the home and meet the staff. Sometimes this is not possible and a representative of the resident is invited to look around on their behalf. A trial stay is offered before the resident makes a decision whether to stay. Observations made during the inspection showed how people referred in an emergency were also given the benefit of an assessment of need prior to being admitted The range of needs for residents in the home had been considered. New staff were trained in ‘resident care’ as part of their recruitment as carers. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The detail in the care plans did not always show what action staff needed to take to ensure all resident’s needs were met. Service users or their relatives had been involved in the care plan process. Healthcare monitoring was not sufficient in helping residents maintain physical and mental wellbeing. Medication procedures were clear, however staff must not delay treatments prescribed by medical professionals and place residents at risk. Staff were trained to deal with those residents who were in the last stages of life. EVIDENCE: It was apparent from the case tracking process each resident had a plan of care based on an assessment of needs. Some of these provided sufficient detail about all aspects of daily living that included preferred daily living routines and the assistance each resident required with personal care. For example dealing with a visually impaired resident had an excellent plan of care detailing what staff must do to support the person in everyday living and maintain independence and dignity. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 12 The plans were reviewed, however in some instances these did not always reflect changing need. Risk assessments had been incorporated into the care plan documentation, and in some instances had been reviewed. Records of personal care generally did not support the care plans. These daily records provided information on changing needs and any recurring difficulties. Some care plans were better detailed and the manager said staff were currently being trained in care planning, as part of staff development. Health care needs were not always fully met. Instances where mental health required input for residents well being were not clear. For example instructions written for staff to involve him in stimulation did not indicate how this would be done, and whilst needs were identified, guidance was not always specific in how staff should act. Reviewing mental health needs was not consistent. Management of aggression needed to be clearer for staff to follow best practice for individuals. In other instances response to skin rashes were not dealt with properly, and communicating concerns about residents between staff and management were poor resulting in treatment delays. There was a lack of weight monitoring. One resident had weight recorded on three occasions and nothing since, although diet was reported as poor. Care notes referred to some residents as poor diet taken. There was no written plan of action when food intake was poor, although the manager and staff said if residents did not eat a substantial diet then food supplements were offered. A supply was available in the home. Continence management did not give staff guidance for residents care, or of management strategies, particularly in the dementia unit. Records show that people did access medical professionals such as district nurse and doctors. A clinical practitioner was appointed to the home conducting blood pressure checks and blood sugar monitoring. Staff had received training from the practitioner to record blood sugars when she was not in the home. One resident was receiving visits from the district nurse for pressure sores. Pressure relieving aids were in place. One resident had bed rails fitted to the bed. These had been risk assessed and agreed by relatives. Other protection methods to reduce the risk of injury from falling out of bed included a crash mat for one resident. The rights of residents to be treated with dignity and respect should be upheld by the procedures within the home. The residents spoken to felt the staff respected their right to privacy and some made complimentary remarks about the staff, for instance one resident said the staff are helpful and If I ring they come straight away. Four out of six responses from residents sent to the Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 13 Commission show they received care and support at the home, and received the medical support they needed. Comments from relatives, however show that respect for residents is not as it should be with issues around privacy. Responses from relatives also show that there was dissatisfaction with the care at times and as one comment read, depending on what staff they have on duty, depends on the quality of care residents have. During inspection a number of residents in the dementia unit walked about in stocking feet. This is dangerous and the explanation of taking slippers off was not satisfactory as alternative footwear should be used. The home operated a monitored dosage system for the administration of medication. The supplying pharmacist audited this. Staff had been trained in medication procedures. An appropriate recording system was in place to record the receipt, administration and disposal of medication. This does need to be followed correctly. One record of medication required the balance to show a clearer audit trail. There was evidence a record of administration of medication had been signed by a member of staff using another staffs name, and on one occasion the Commission was notified of an error made of a resident being given wrong medication. There was also evidence that in one instance there was a delay in treating a skin infection with a topical solution. The manager said the resident would not co-operate, however care notes did not support this. Resident’s doctors approved homely remedies for individual residents. The manager said that plans for all staff to have specialist training in the care of the sick and dying were being made. Some staff had done palliative care training, and comments received at the home show appreciation for the care given during these moments by staff. For example we always felt she was happy and well looked after. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. The home did not provide residents with a sufficient range of suitable activities that would meet their needs and expectations. How visitors are received needs to improve. The residents were offered a balanced and varied selection of food. Improvement was required for residents accommodated in the dementia unit that met with individual tastes and choices. EVIDENCE: The residents’ preferences in respect of social activities was not fully met, although this had been recorded as part of their assessment. Residents choice in relation to routines of daily was recorded for example times for getting up and going to bed. Residents confirmed they pleased themselves. A record of residents’ interests and preferences was held on the care plan. An activities organiser planned and presented activities and arranged outings. Some residents comments indicated activities were arranged, ‘but lately they haven’t been very good.’ There was a notice to show what events were planned, but this was displayed in the hallway and a number of residents would not be able to see this. The events planned were interesting and included a trip out, sweet making, movement to music and Communion on a Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 15 Sunday. In response to a recent allegation regarding no activities for people in the dementia unit, the manager said there has been difficulties in this area. Observations during inspection found that residents in the dementia unit were not supported effectively to engage in meaningful activities. Group activivities did take place and old time music was constant. Whilst this is entertaining to a degree, it required modifying to allow dementia sufferers an opportunity to experience possible lucid moments to their full capacity. The various noices, eg TV, music and everyday living noise combined together could be more confusing. One relative wrote although they are supposed to do activities, I dont see them doing any. Comments from Residents and relatives gave a mixed view as to the arrangements for visiting. Residents felt they could see their relative in private. Relatives felt that although they were given privacy however, staff attitude at times was not as it should be and on one occasion a relative had been unable to access the home as no-one answered the door. Another relative at the home during inspection said ‘most staff are nice, but some are not.’ It was apparent from a tour of the premises that the residents were able to bring in personal belongings and arrange their rooms how they wished. The manager maintained a record of items brought into the home by residents and their families. The residents made varied comments about the food. One resident said “the food is good and I can have what I want, another resident purchased her own fruit. When asked said ‘I always buy it. Occasionally we get fruit, but I love to eat it and like having my own’. The cook said there is always alternatives on offer for the residents. Sample menus received at the Commission showed that on occasions variaions were similar. For example, breaded haddock or poached cod. Records were kept of meals served. The provision of meals in the dementia unit offered no real choice and how to manage this more effectively was discussed with the manager. The way meals are served in the unit also needed to improve as people with dementia were seen to leave the table due to the length of time waiting for a meal. Residents were fidgety and some were agitated. The menu board offered choices but only one meal was offered. Most residents thought the food served was good. The dining area in the residential unit was spacious. In the dementia unit there were two dining rooms. Staff were observed to provide suitable assistance to residents. Residents were supported to continue to practice their chosen religion. Representatives from local churches visited the home on a regular basis for prayers and communion. Arrangements were made for residents to have meetings. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. Whilst residents and relatives/visitors had access to a clear up to date complaints procedure, this needed to be promoted better. Complaints were not always recognised as complaints and therefore not dealt with properly. Staff had access and an awareness of the adult protection procedure. Response to abuse incidents needs to improve. EVIDENCE: A copy of the complaints procedure was displayed in the home, and was included in the information given to current and prospective residents. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. Four complaints had been sent direct to the Commission. Whilst the complaints had been investigated, comments reveived at the Commission showed that from six responses three residents knew how to make a complaint. Responses also showed residents knew who to speak to if not happy. Comments received from relatives showed five out of nine people did not know the homes complaint procedure. One comment read, I have made several approaches to the manager about this ariel but as yet nothing is done. During inspection one relative spoke about the poor attitude staff had when she approached them regarding her relative wearing only stockings with no slippers. Care records showed that one resident was frequently found in other residents bedrooms. This was discussed with the manager as it is an invasion into someone elses space and can lead to an adverse reaction between residents. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 17 Strategies to protect personal space for each resident must be implemented for example bedrooms clearly showing the name of the occupant and securing bedroom doors for people who are unable to do this. One comment from a relative shows that regularly we have requested his door be kept locked when he is not in his room, but we feel there is a lack of respect for family feelings. All staff were clear about protection issues and of their responsibility to report any suspician of abuse. The home had a copy of “No Secrets in Lancashire” and an appropriate internal procedure for staff to follow should they suspect or witness an incident of abuse. A whistle blowing policy was in place for the reference of staff. Adult protection training is covered in staff resident care training and is mandatory. Three referrals have been made to the adult protection team. The manager had not acted promptly on one occasion and was prompted by the Commission to follow protection guidance. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. The standard of the environment both internally and externally was poor. Although there had been some improvement internally the home did not create a safe and attractive environment for those living there. EVIDENCE: The home is a large adapted detached property set in its own grounds in a residential area of Bamber Bridge. The front of the home is next to a park boundary and a number of large trees gives the home privacy. Car parking is to the front of the home. The outdoor area generally requires some maintenance. This included for example filling in potholes in the drive. The garden areas were overgrown with weeds. Residents can sit outside at the back of the home. During inspection residents sat out and enjoyed ice lollies and celebrated a birthday with afternoon tea. The path from the home to the outside is ramped, although deposits of debris from trees and weeds had gathered and required tidying up for residents and staff safety. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 19 Residents were not happy at losing the front garden area they used to enjoy and the fishpond at the back. One resident said I used to watch the fish every day, it was lovely and I dont know why they filled the pond in. Another resident asked could you get the front garden back for us, we used to have barbeques. Comments received at the Commission as part of the inspection requested an improvement to be made in the garden. The home is divided into two units for residential and dementia care. Access to both these units is via a controlled lock opened by a push button to access and key pad to leave. Following a tour of the premises, the following observations were made. The dementia unit generally was odorous, with one bedroom in particular. Bedrooms on this unit had adjoining doors that had not been permanently sealed and two rooms had the adjoining door unlocked. Furniture in some bedrooms was poor in quality for example chest of drawers and wardrobe were broken. The vanity unit top around sinks were crumbling and the formica flaking. One room needed a safer stand to support a large television. In addition to this some rooms required decorating, and floor coverings required proper repair or replacing. To help residents orientate themselves clearer names on doors were needed. The decoration in the unit was dull in corridors and required some improvement to create a homely environment. The lighting in the unit was poor on the corridors. Heating was on despite the weather being hot,requiring better control. The manager was advised guidance was available for dealing with ‘heat waves’ in residential homes. The unit was untidy in places with residents clothing/belongings that needed to be removed. The manager thought these might be clothes with no names on. Sluice facilities were dirty and needed to be kept clean. The residential unit also required some general improvement and upgrade, with better attention made to keeping it clean and tidy. The dining areas and lounge were pleasant. A written comment from a relative indicated ‘staff smoke in the dining room and my parents never had to tolerate smoke in their home(passive smoking) causing chest problems.’ The kitchen needed upgrading. This included decorating. Tiling on the ceiling required replacing. The cook said she needed better equipment and hoped when she transfers to Southern Cross employ, they would provide this. The laundry was unorganised with large amounts of washing littering the floor. Little respect was given to residents clothing that were found unfolded on shelving. The manager said they would have no names on, however from looking at several items of underwear they were named. A large number of residents slippers were on wall pegs, they were dusty and the manager could Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 20 not identify who they belonged to. The manager was asked to organise a cleaning programme and keep the laundry in a better state of hygiene. Staff responsible for cleaning said there was shortage of domestic help. The size of the home meant only the basics throughout the home were dealt with and routine shampooing of carpets was difficult. Carpet shampooing was if care staff reported major continence accidents only. Comments received from a relative stated, I went upstairs to inspect a room for my father, and the floor was dirty and couldnt walk on it and it smelt. The sluice was dirty. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. The level of staffing was not satisfactory to make sure the home was maintained to a satisfactory level of hygiene and residents needs being met. Recruitment practices were mainly good, however the high turnover of staff did not provide residents with a continuity of care. Residents had confidence in the staff working at the home. Essential training for all staff provided did not meet with basic standards. EVIDENCE: The rotas were clear. The manager had maintained a written staff rota. Copies of rotas were sent to the Commission. These showed how the level was arranged for residents needs being met and senior staff were on duty at all times. In response to a complaint regarding staff working excessive hours, the manager said there had been shortfalls in staffing levels recently and on one occasion a carer had worked a day shift through the night. This was a result of being let down by a carer and no agency available to cover this. The numbers of staff employed however did not make sure that the home was maintained to a satisfactory level of hygiene and the needs of the residents being fully met. A large number of staff had left their employment since the last inspection. Reasons for leaving were recorded on information received at the Commission and included absent from work, personal reasons and dissatisfaction with the job. Comments received from relatives questions, how can two care assistants plus a senior(not always available) tend to the caring duties. If one goes off Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 22 sick the agency carers are not familiar with residents and are not always very good. This situation is letting the servce down. Another comment read sometimes difficult to find staff. One visitor had travelled from outside the area and had been unable to gain access to the home as no-one answered the door. From eight responses sent to Commission all felt there were not enough staff on duty. Residents said they were ‘well looked after’ and that some of the staff were ‘good’. Several new employees records showed how recruitment practice was carried out. Employment checks had been completed. Criminal Record Bureau clearances were not all in place, but all new employees had Protection Of Vulnerable Adults checks. Information sent to the Commission in a pre inspection questionaire show that not all staff had a record of police clearance, particularly those staff who transferred employment to Ashbourne (Eton) Limited. The manager was currently dealing with this. One reference had not been signed and dated by the referee. The manager said all staff received a contract of employment. Staff on duty confirmed they received induction training that covered policies and procedures and basic care. Two new employees recruited from oversees had no induction record. The manager said this had been given by the company prior to working at Withy Grove. There was no evidence of their orientation induction given in the home such as fire procedures. Information received at the Commission showed that the percentage of staff having accomplished a National Vocational Qualification in care level 2 and above was 43 , falling short of minimum recommendations. Staff had a written training assessment and profile which showed other mandatory training had been provided. Information sent to the Commission from the manager showed training had been planned for the year. This information showed the number of staff with first aid was six and therefore not sufficient to cover the home at all times. The manager said training was ongoing and included essential training like moving and handling, fire, food hygiene, health and safety, resident welfare, tissue viability, care planning training and medication training. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Administration in the home was generally well managed. This included financial arrangements to safeguard residents. Health and safety of residents and staff was considered, but required more staff trained in first aid. Staff were trained to keep themselves safe when working. The quality assurance systems required development to fully monitor the service received by the residents. Improved relations with relatives and staff needs to be encouraged. EVIDENCE: At the time of the inspection the manager was not registered at the Commission but had attended an interview for registered manager and was awaiting the outcome. She is a qualified nurse and has many years experience of working in and managing care services for older people. The registered providers, Ashbourne (Eton) Limited have an active role in the management of Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 24 the home and visit once a month to oversee management performance, and give the manager supervision. The manager was clear about her role and responsibilities, and recognised the need to improve in all standards that were not met. Staff said they were confident in the manager and would approach her any time for advice. The manager is supported by a deputy manager, unit managers and senior carers. There was a lack of effective communication and the management team need to work together to support the manager bring about change for the benefit of the residents. Progress had been made to monitor the quality of the service with quality assurance systems being developed. For example residents and staff benefited from regular meetings. A meeting for residents and relatives had been held in April this year. The views of relatives must be considered when monitoring the service residents receive and action taken to improve the standards some staff work to. All responses received at the Commission from relatives showed they were informed by management of important matters affecting their relative. Residents who are able manage their own finances continue to do so. Small amounts of money are managed for residents wanting this service. Records were kept of transactions made on behalf of people. There was a set of policies and procedures, and according to written documentation sent to the Commission, these had been reviewed in line with current good practice and legislation. To make sure staff read and understand these documents they are included in staff meetings and supervision. Supervision was being given to staff, however the frequency of these sessions must increase. One staff member said they were three monthly, another said six monthly. Senior staff had responsibilities in this area. Staff said the supervision covered work issues and considered them useful. New staff benefited from induction training and their work supervision was ongoing. Return to work interviews after absences of sickness were not completed for all employees. Written working procedures and training opportunities were available to support development of good care practice. All new staff members were receiving induction and essential training. This training must include first aid.. Fire safety procedures were evidenced as being given to staff and regular fire drills carried out. Information contained in the pre inspection questionnaire indicated that gas and electrical safety certificates were up to date. Water temperatures at source, and in bedrooms, had been regularly checked and were being maintained close to temperature as required. One outlet in a bathroom was high and the manager was unsure whether a thermostatic safety valve had been fitted. The storage of cleaning products was satisfactory. Information received at the Commission during the year showed whilst the the manager reported significant events and occurrences when they occurred, Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 25 important issues however were not always dealt with effectively. Communication between shifts was required to improve as a management issue for proper care of residents. Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 2 X 2 2 2 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 3 2 Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14(2)(a) (b) 15(2)(b) (c) 13(1) 13(1)(b) Requirement Assessment of residents must be kept under review and revised to show any important changes to need. Care plans must be reviewed properly to show how changes in peoples needs are to be managed. Healthcare needs must be managed responsibly. Advice must be sought from health care professionals to make sure residents receive timely treatment. All areas in the home residents have access to must be free hazards to their safety by providing designated smoking areas staff and residents can use. Medication prescribed to control the spread of infection must be administered as soon as possible Correct procedures for the recording of and administration of all medication given to residents must be followed. Residents dignity must be respected at all times by making sure residents are properly dressed that includes wearing adequate footwear. DS0000065186.V296713.R01.S.doc Timescale for action 26/06/06 2. OP7 26/06/06 3. 4. OP8 OP8 26/06/06 26/06/06 5 OP8 OP25 13(4)(a) 26/06/06 6. 7. OP9 OP9 13(4)(c) 13 (2 26/06/06 26/06/06 8. OP10 12(4) 26/06/06 Withy Grove Care Home Version 5.2 Page 28 9. OP12 16(2)(n) 10 11 12 13 14 15 16 17 18 19 OP13 OP16 OP18 OP18 OP19 OP19 OP19 OP20 OP20 OP23 16(2)(m) 22 13(6) 12(4)(5) 16(2)(k) 23(2)(d) 16(2)(g) 23(2) 23(2)(o) 16(2)(c) 20 OP23 16(2) 21 22 23 24 OP25 OP25 OP26 OP26 23(2)(p) 23(2)(p) 16(2)(e) 23(2)(d) Activities should be made available for all residents to meet their individual needs in relation to promoting their wellbeing. Arrangements must be made for visitors to be allowed reasonable access to the home. Complaints made must be properly investigated. To make sure residents are protected abuse procedures must be followed at all times. People’s views must be listened to when they request staff to respect the privacy of residents. The home must be kept free of offensive odours. The home must be reasonably decorated to include corridors, bedrooms and kitchen. Tiling missing and loose in the kitchen must be replaced and repaired. The driveway must be maintained. The garden paths must be cleared of debris and the gardens maintained. Residents must be provided with adequate bedroom furniture to replace the damaged/broken furniture currently provided. Adequate floor coverings must be provided for resident’s bedrooms to include the replacement of the carpet currently repaired with tape. Lighting in the dementia unit must be improved. Heating must be controlled well in hot weather. Proper arrangements must be made for the laundering of linen and clothing. The home must be kept clean 26/06/06 26/06/06 26/06/06 26/06/06 26/06/06 26/06/06 04/08/06 07/07/06 04/08/06 14/07/06 04/08/06 04/08/06 26/06/06 26/06/06 26/06/06 26/06/06 Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 29 25 OP27 18(1)(a) 26 OP31 12(5)(a) 27 OP33 12(5) 28 OP38 13(4) Sufficient numbers of staff must be employed for the health, welfare and safety of residents and to maintain a satisfactory level of hygiene. The registered provider and manager must maintain good working and professional relationships between staff. The registered provider and manager must in relation to the conduct of the home create an environment that encourages and assists staff to maintain good personal and professional relationships with residents/representatives. Arrangements must be made for the training of staff in first aid. 07/07/06 26/06/06 26/06/06 04/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5 6 7 8 Refer to Standard OP8 OP8 OP9 OP12 OP12 OP13 OP15 OP15 Good Practice Recommendations It is recommended all residents have regular nutritional monitoring. It is recommended care plans are sufficiently detailed for staff to follow when caring for residents. It is recommended all medication show a clear audit trail particularly with less frequently used medication such as Diazepam. It is recommended the activities notices be displayed in both units. It is recommended that the use of music for recreation be better organised to benefit residents. It is recommended resident’s visitors have reasonable access to the home for the purpose of visiting. It is recommended residents in the dementia unit be given the option of choices of meals served. It is recommended residents in the dementia unit be served meals promptly. DS0000065186.V296713.R01.S.doc Version 5.2 Page 30 Withy Grove Care Home 9 10 11 12 13 14 15 16 .17 18 18 20 21 22 23 24 25 OP15 OP16 OP23 OP23 OP23 OP25 OP26 OP26 OP26 OP26 OP27 OP28 OP29 OP29 OP30 OP31 OP33 26. 27. 28. OP36 OP36 OP38 It is recommended choices offered of meals served in the home are more than a variation of the same. It is recommended the complaints procedure be promoted in the home. It is recommended residents in the dementia unit be provided with easy recognisable nameplates on their door. It is recommended the bedroom doors be painted in a more homely colour. It is recommended the adjoining doors in bedrooms are kept locked and disguised to minimise confusion in the dementia unit. It is recommended guidance on managing ‘heat wave’ in residential homes be obtained. It is recommended residents slippers taken to the laundry are returned to residents as a matter of course and not left on wall pegs. It is recommended residents clothing are properly labelled and returned to residents as soon as possible after being laundered. Evidence of compliance with the Water Supply (Water Fittings) Regulations 1999 should be available for inspection. It is recommended sluice facilities are cleaned after use as routine. Sufficient staff should be employed to make sure that in the event of sickness or annual leave, numbers on duty could be effectively maintained. 50 of care staff should hold NVQ Level 2 It is recommended references obtained for staff are signed and dated. It is recommended a record be kept to verify a police clearance check has been carried out for all employees. It is recommended care staff be trained in essential first aid. It is recommended the management team as a group have clear defined roles that encourage working together. To make sure staff have the opportunity to pass on information to senior management, arrangements should be made for them to meet with the manager/unit manager periodically during the day to update them of any changes required for residents care. Care staff should receive formal supervision at least six times a year It is recommended as good practice staff are given a return to work interview following a period of sickness. Water temperatures in bathrooms must be controlled to provide safe bathing facilities. DS0000065186.V296713.R01.S.doc Version 5.2 Page 31 Withy Grove Care Home Withy Grove Care Home DS0000065186.V296713.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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