Care Home: The Willows

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What the care home does well The staff team and manager have been in post for many years and this provides stability and consistency of care for all people. What has improved since the last inspection? The lounge has been recently decorated as well as two of the resident`s bedrooms. What the care home could do better: At present the statement of purpose and service users guide is not annually updated or in a format of the resident`s choosing (this needs to be explored further). The majority of the people who live at the Willows care home have complex communication needs and this needs to be further explored to enable all residents to make choices and participate in everyday life as much as possible. At the last inspection (22nd May 2007) and again at this inspection, issues have been raised about the standard and frequency of general renewals, replacement and redecoration of the home. This is still a repeated issue and many areas of the home are dated and looked tired, therefore we discussed with the manager the possibility of keeping a maintenance log of what short and long term improvements they intend to make. This will ensure the people that their home will be improved upon and be kept fit for its intended purpose. As well as the in-house induction process, all new staff need to follow the Skills for Care sector criteria set out for the induction process. Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows 30 Hunnable Road Braintree Essex CM7 2NU     The quality rating for this care home is:   two star good 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: Sarah Hannington     Date: 0 4 0 8 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 Adults (18-65 years) Page 2 of 29 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 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 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 Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Willows 30 Hunnable Road Braintree Essex CM7 2NU 01376550669 01376550779 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Linda Samaranayake,Mrs Muriel Howe care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One female, over the age of 65 years, who requires care by reason of a learning disability (not to exceed 1 person) Persons of either sex, under the aged of 65 years, who require care by reason of a learning disability (not to exceed 6 persons) Date of last inspection Brief description of the care home The Willows is a care home providing personal care and accommodation for six adults with learning disabilities. Mrs Muriel Howe and Linda Samaranayake who is also the registered manager, privately own the home. The property is a detached house that has been adapted and is situated in a residential area close to Braintree town centre and is on a regular bus route to Chelmsford and Colchester. Local amenities include supermarkets, church, library, post office, bank and building societies and newsagents. Accommodation consists of four single and one shared bedroom, which is on the ground floor. There are two bathrooms, a separate WC and a lounge/dining room and an activities room. There is a secure private rear garden with a patio. People in residence have lived at the home for more than ten years. A minibus is available for Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 1 0 Brief description of the care home outings. The accommodation fees as at 22nd May 2007 were stated by the manager as being up to a maximum of #750 per week. Extras to the fees include chiropody, hairdressing and toiletries. Inspection reports are available from the home and the CSCI website www.csci.org.uk 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced site visit took five hours to complete and was carried out as part of the annual inspection programme for this service. This visit was conducted with assistance from the manager/Provider. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. We looked at all the information that we had received, or asked for, or what the service has told us about things that had happened in the service since the last inspection. Two staff were spoken with during the site inspection. Prior to this site visit, CQC (Care Quality Commission) sent out surveys to all interested parties, however none were returned to us, the reason for this (we were told by the manager) is that the home had not received them. Additionally the manager was sent an (AQAA) Annual Quality Assurance Assessment form by us. This is a self assessment required by law that asked how well the service is meeting the needs of the people who live at Willows Care Home. Care Homes for Adults (18-65 years) Page 6 of 29 All information obtained was triangulated and reviewed against the commissions key lines for regulatory activity. This helps us to use the information to make judgments about the outcomes for the people who use this service in a consistent and fair way. The last key inspection for this home was carried out on the 22nd May 2007 and in between they had an annual service review carried out on the 3rd April 2008. Care Homes for Adults (18-65 years) Page 7 of 29 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 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 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. A clear and comprehensive assessment process assures people that their needs could be met prior to moving in their home. Evidence: The manager told us in the Annual Quality Assurance Assessment that there is a statement of purpose and resident guide, which provides information about the home to help people decide if they would be happy there. When we visited the home we looked at the current statement of purpose and resident guide. These guides are informative and give people the knowledge about the staffing group, their skills and qualifications, the home and support offered. To allow all people at the Willows to understand the information better than it presently does, these documents need to be provided in different formats of the residents choosing. They also need to be reviewed annually to correct any outdated information. When we visited the home we looked at the way in which the manager had assessed all peoples needs. We saw that the assessment covered details of the persons physical Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: and health needs as well as the support the individual required to maintain personal and oral hygiene. In all documentation each persons communication needs, their likes, dislikes and hobbies would also be recorded to help determine that the home would be able to meet their needs. The manager told us that a copy of the social services or local authority needs assessment is also obtained and that people are invited to visit the home before they move in and once they do a contract would be agreed. These were seen in all resident files looked at. 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. Residents assessed needs are followed through in good care plans that give staff the necessary information to provide good care outcomes. Evidence: The manager told us in the Annual Quality Assurance Assessment that each person had a care plan and that they were involved in this process as much as possible. All six of the Care Plans seen were reviewed at least every twelve months or more often when this was appropriate to do so. The manager told us that emphasis was put on enabling residents to make decisions and choices about their daily lives. When we visited the home we looked at the way in which people had been initially assessed and monitored since their admission. This was seen as consistently achieved, as the changing needs recorded of all people were addressed. All residents have recently had a mental capacity assessment carried out, (this is to find out how much comprehension a person has to make important choices in their lives) such as, receiving medical treatment, looking after finances or understanding particular Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: restrictions they may have imposed upon them to reduce the risk of harm to themselves or others. When we visited we looked at all care plans for all of the people living in the home care plans included things such as, personal details, a recent photograph, initial and up to date assessment, short and long term goals, professional reports, medical profile and medication they were prescribed, activities and any other issues specific to that individual. Care folders were split up into sections such as, social, emotional, physical, leisure, activities and mobility. We saw that all peoples wishes were included (described wishes were recorded by staff and information mainly given by families) and were seen as being carried out. We could see by the recorded information held within peoples daily notes, (that staff completed on a daily basis for each person) confirmed that peoples choices were carried out. Staff recorded what they knew about peoples likes and dislikes or preferences related to issues, such as, meal times, food people like to eat or not and the same with drinks, preferences of getting up, going out, bathing, getting undressed or going to bed. (again recorded from a staff observations carried out rather than directly from the people themselves.) Care plans were reviewed and amended where there were changes to the support that the individual needed. We looked at reviews which had been carried out by the people who pay for people to live in the home (Social services, the health authority and relatives). We saw that some peoples care had been reviewed by their social workers and that both were satisfied with how the way that residents were supported and cared for. Where risks were identified there were plans in place so as to minimize these while supporting residents to participate in the activities they chose and remaining as independent as possible. Risks to residents health and safety were well recorded, well managed and reduced the risk. 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. People using the service can be confident that their identified needs will be met appropriately. Evidence: The manager told us in the Annual Quality Assurance Assessment that residents are supported to develop skills and to participate in activities of their choice both in and outside of the home. When we visited the home we looked at all of the residents care plans. We saw that all residents had a plan of care which described their wishes (information gathered by staff from various sources and by observation) for the activities they wish to participate in such as, keep fit, books, puzzles, swimming, drive out in the minibus (which the home provides) skittles and bowling, Lego and other games, horse riding, drama, relaxation, netball, music therapy and football. People also had the choice to attend local day centres and evening clubs and one person has the sole use of their own laptop and mobile phone. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: The majority of people living at the Willows have varied complex ways of communicating their needs. Therefore we saw that the majority of information gathered and recorded is from knowledge gathered by staff observation rather than residents participation. The care plans told us that people use a mixture of Makaton, body language, audio equipment to indicate choice and one person living at the Willows is very independent and able. Looking at staff training, it revealed no one had undertaken recent Makaton training and by our observation on the day of the inspection, it was not actively used with people. Additionally on our tour and looking through documentation, we saw that no tools, such as, photographs, symbols or reference aids were used. (Things that may support people better, to make choices) Looking at one persons record (a person who was independent), it showed us that there had been a lapse in following guidance given by a professional to learn independent skills. Speaking with staff they told us that this was due to this person not wishing to participate in preparing or cooking their own meals. Speaking with the manager she expressed that this may because of the environment that this person presently lived (other people not carrying out these tasks) and this was being addressed by her for the longer term welfare of this person. Presently the majority of choice offered to individuals is mainly relying on staff judgment to make decisions on their behalf. The manager agreed with us that even if there is very limited or no strategies available that would support people further, then at least documenting that staff had tried would be a positive step (and to record why things did not work), this will highlight that the staff are proactive in exploring different options and being proactive in trying to include people as much as possible. Looking through all peoples nutrition records it showed us that staff supported residents to eat a healthy and well balanced diet and that they monitored weight on a regular basis. The staff at the home cook all meals for people and their training information showed us that they held the relevant qualifications need for this role such as, food hygiene and infection control. Records showed us that they kept a log of regular checks of the kitchen, foods, temperatures and equipment. We saw that a four week menu was place and showed us that the likes and dislikes of residents that were recorded in their information were reflected in the meals provided. Nutritionally the meals were good and provide people with a varied and good quality of diet. The lunch time meal seen was of good quality and home cooked and presented nicely. Observation showed us that people seem to enjoy the meals provided. 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. Staff are successful in delivering appropriate care to all residents. Evidence: When we visited the home we looked at how the personal and health care needs of the residents were assessed and how residents were supported. The health care plans of all residents showed us that, all people had good access to medical professionals and facilities such as, GP, consultants, psychology, dentist, opticians, chiropody, occupational health and other specialist services.Staff recorded these visits well. Ensuring that outcomes and action were followed through for all people. All people looked well cared for and at ease within the with the staff on duty. The manager told us in the Annual Quality Assurance Assessment that the health and personal care needs of residents are met and that staff are trained to administer medicines safely. We saw that the staff who administers medication had been trained and speaking with them understood their responsibilities. At the time of the inspection none of the residents living in the home were capable of safely keeping and administering their medicines, therefore we saw that a monitored medication dosage Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: system is in place for each resident. We looked at medicine administration records and these were completed accurately to show that residents received the medicines, which were prescribed for them. There have been no incidents reported around medication issues or practice would suggest that medication is kept to a strict protocol and is maintained consistently to a good standard. 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. There are systems in place to ensure that peoples views are listened to and acted upon and that support residents from abuse. Evidence: We were told in the Annual Quality Assurance Assessment that any complaints or safeguarding alerts would be dealt with openly and thoroughly. The manager told us that residents relatives are provided with information on how to complain and how their concerns would be dealt with. The manager told us that there had been no formal complaints made about the service within the past twelve months. They also told us that staff received information about dealing with complaints and whistle blowing when they commence work at the home. When we visited the home we looked at the policy and procedure in place for recording and dealing with complaints. The manager showed us that she has good systems in place to deal with any complaints that may be received. There was a safeguarding policy and procedure in place and the manager told us that there have been no safe guarding issues. We saw that all staff have had safeguarding training and speaking with them knew their responsibilities well. The manager had in place the local authority safe guarding information for all staff to refer to if need be. Care Homes for Adults (18-65 years) Page 18 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. People live in a clean and safe environment. Evidence: The manager told us in the Annual Quality Assurance Assessment that it is clean, smelt fresh and was comfortable. The provider told us that there are longer term plans to eventually redecorate the whole of the home. (Recently the home has redecorated the lounge area and two residents rooms.) A tour of the home inside and out revealed to us that there were many areas in which decoration and updating could be improved upon such as bathrooms, toilets and generally in communal areas. Additionally independent access by people into the garden was difficult as there were no ramp, handrails or flat surfaces provided to step out onto. The shed in the back garden is leaning, this needs securing to prevent any harm occurring to people. We discussed with the manager the need to have in place an action plan that addresses general maintenance issue so that the up keep of the service as a whole is gradually addressed and put into place. The home was seen to be clean, comfortable and personal rooms were furnished with items which reflected the peoples personality and likes (such as pictures, ornaments, games and music and DVDs). Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: All staff carried out peoples laundry and the cleaning of the home. Staff records showed us that they had all had infection control training. The manager showed us that she had a self assessment tool (NHS infection control guidance and work book) that helps her monitor, keep regular checks on the effectiveness of the homes hygiene, cleanliness and safety systems that are presently in place. Care Homes for Adults (18-65 years) Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered positive relationships by well-supported and caring staff and are protected by staff recruitment, induction and training. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home did not rely on the use of temporary agency staff. That all staff were recruited thoroughly, that staff were well trained and that staffing levels meet the needs of all residents. When we visited the home we saw by observation and by looking at the staff rota that there were enough staff to cater for all residents needs. The manager told us that all staff had a detailed job description in relation to their jobs, that they had an induction to the service when they started work and that they received both mandatory and specialist training to best support people. When we visited the home we looked at staffing levels and how staff were recruited, trained and supported to meet the needs of residents. We looked at the recruitment files for ten staff. There was information recorded about how before staff commenced work that satisfactory employment references, Criminal Records Bureau disclosures and PoVA First checks had been obtained and a full ten year employment history was checked for all people. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Staff who were spoken with confirmed that they had checks, such as Criminal Records Bureau disclosures and that these had been obtained before they commenced their employment. Staff also told us that they received training, which was relevant to their roles and that helped them understand the needs of people. We saw that staff had received training in safe moving and handling, safeguarding, administration of medicines, communication, infection control and health and safety. Staff had received training in respect of caring for people who have learning disabilities, such using makaton or training around supporting people to make choices. The manager told us that over 50 of the staff are NVQ trained. Looking staff files information held told us that this was the case and that 50 of staff have now obtained a National Vocational Qualification at level 2 and above. Staff told us that they have regular staff meetings, supervisions and yearly appraisals and were seen by us to be in place for all staff. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is stable which ensures the health, safety and welfare of all residents. Evidence: The registered manager has been in post for many years, has achieved much and holds a wealth of experience and knowledge of the current resident group and this goes toward securing the health, safety and welfare of all people. It also provides consistency of care and supports staff to maintain the quality of care given to people. We looked at the arrangements for ensuring that the home was maintained safely. We saw that regular checks were carried out on equipment such as hot water and heating systems, fire alarms and fire fighting equipment, gas and electrical installations and equipment. All equipment was well maintained and repaired as required. When we visited the home we saw that there were risk assessments in place to identify where each person may be vulnerable such as in managing money. Staff supported residents to access money from their bank accounts and kept good records where monies were held for safekeeping on residents behalf. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: We looked at how the views of residents, their families and other people who were important to them were obtained and acted upon. Questionnaires were sent to residents and other people each year to ask them for their views about the home and the findings from these were analyzed as part of the overall system for monitoring and improving the quality of the service. Care Homes for Adults (18-65 years) Page 24 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 25 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The statement of purpose 31/12/2009 and service user guide is not up to date. This is because the statement of purpose and service user guide are out of date and need to be written in a format of all residents understanding. 2 24 23 The premises are fit for 30/04/2010 purpose and are appropriate to the needs of the residents. This is because access to the garden is not possible for wheelchair user or people who have sight or mobility issues and therefore cannot access independently. 3 36 18 That all staff are appropriately supervised. This is because at present there are no staff meetings held therefore sharing of 31/12/2009 Care Homes for Adults (18-65 years) Page 26 of 29 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 information and strategies are limited. 4 39 24 That there is a system for reviewing quality of the service provided. At present there is no systems in place to assess and gain the views from residents, their families or other professionals who come into contact with the home. 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 31/12/2009 1 6 That the care plans include all peoples views, or views of their representative of the care support they receive and how this is be carried out. That residents have access to advocacy if there is no relative, friend or representative involved within their care. This will allow them their right to make decisions independently from the staff of the home. That reference tools are developed and used for residents such as pictorial, photographs, symbols etc to enable people to make better choices within the home in general. At present not all peoples permission and choice are not fully explored. Staff have not had recent makaton training or advocacy or specialist services are not presently accessed for the benefit of all people who live at the willows. The home needs to be clear of furniture and clutter that is not in use and communal rooms such as the activities room, lounge on the first floor is made more spacious, inviting and homely. Page 27 of 29 2 7 3 8 4 16 5 24 Care Homes for Adults (18-65 years) 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 6 43 That there is a yearly financial audit of all residents monies and these are kept on the premises by the manager. Care Homes for Adults (18-65 years) Page 28 of 29 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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