Care Home: The Willows Nursing & Residential Home

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What the care home does well The care plans reviewed were detailed and provided good information for nursing and care staff so that they were able to quickly identify and address residents` specific healthcare needs. The Registered Manager ensures that residents and relatives are fully informed and involved in the care planning process and invites relatives to reviews and meetings where this is appropriate. Staff were friendly and helpful towards the residents in a quiet and supportive manner. Food was nutritious and well presented and all residents had nutritional assessments and had had their weight regularly monitored. Staff training is well supported and carers are encouraged to undertake National Vocational Qualifications (NVQ) in Care to add to their care skills. Approximately 75% of care staff have gained an NVQ level 2/3. What has improved since the last inspection? The Willows continues to provide a good standard of care. There is a rolling redecoration programme of fixtures and fittings. New armchairs have been purchased, some new vanity units fitted and some carpets replaced. One of the ground floor bedrooms was being redecorated and provided with new flooring and vanity unit during the last inspection. This has been completed and is now occupied. All areas of the home were fresh and clean. All hand basins, accessible to residents, now have thermostat valves to ensure that the water temperature is controlled and cannot scald the residents. What the care home could do better: The Willows should implement and/or improve person centred care plans for all residents that reflect his or her personal requirements and social interests, and demonstrate how these are being met. As people seemed unsure if they had received a Statement of Purpose, Service Users Guide and/or a copy of the complaints procedure it is recommended that these are provided for residents in their rooms so that they, and their relatives, have the information to hand. Staff should ensure that residents are assisted to move and/or be taken to the toilet regularly throughout the day in accordance with a care plan that identifies the possibility of a risk of pressure ulcers, or requires the promotion of continence. People who choose to remain in their `comfy` chairs, or room, at meal times should have individual tables adjusted so that they can eat comfortably and have their drinks placed within easy reach at all times. Staff should ensure that plate guards are used correctly enabling people to see what they are eating. CARE HOMES FOR OLDER PEOPLE The Willows Nursing & Residential Home 105-107 Coventry Road Market Harborough Leicestershire LE16 9BX Lead Inspector Mrs Carole Burgess & Linda Clarke Unannounced Inspection 5th November 2008 09:30 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 The Willows Nursing & Residential Home DS0000001934.V372781.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. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Nursing & Residential Home Address 105-107 Coventry Road Market Harborough Leicestershire LE16 9BX 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) 01858 463177 01858 434772 Mr James Frederick Cooper Mrs Mary Violet Cooper, Mrs Jacqueline Marie Riddett, Mr John Frederick Cooper Mrs Jacqueline Marie Riddett Mrs Mary Violet Cooper Care Home 57 Category(ies) of Dementia (9), Dementia - over 65 years of age registration, with number (9), Mental disorder, excluding learning of places disability or dementia (9), Mental Disorder, excluding learning disability or dementia - over 65 years of age (9), Old age, not falling within any other category (57), Physical disability (36), Physical disability over 65 years of age (57), Sensory impairment (36), Sensory Impairment over 65 years of age (36), Terminally ill (36), Terminally ill over 65 years of age (36) The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No person falling in categories TI(E) & TI to be admitted to the Home when 36 persons of that category/combined categories are already accommodated Service user numbers No person falling within categories MD, MD(E), DE, DE(E) may be admitted to the Home when 9 persons in total in these categories/combined categories are already accommodated within the Home No person falling in categories PD(E) & PD to be admitted to the Home when 57 persons of that category/combined categories are already accommodated in the home No person falling in categories PD may be admitted into the Home where there are 36 persons of category PD already accommodated within the home No person falling in categories SI(E) and SI to be admitted to the home when 36 persons of that category/combined categories are already accommodated No one under the age of 55 falling within categories MD or DE may be admitted to the Home Named person To be able to admit a named person under 55 years of age and falling within category LD named in variation application No. 58114 dated 13/11/03 12th February 2008 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: The Willows Nursing and Residential Home is situated close to the centre of Market Harborough. It can provide care for up to fifty-seven older people with a range of needs including physical disabilities, dementia, and sensory impairment. Registered nurses are on duty in the home at all times. The accommodation consists of two older buildings linked by a new wing. Bedrooms are on two floors accessed by both passenger and stair lifts. There are four sitting rooms and one dining room. The home stands within secluded gardens and there is car parking at one side. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 5 The Statement of Purpose, Service Users Guide & Inspection Report are available on request (these provide information on how the home is organised and what services they provide). The Statement of Purpose and Service Users Guide are provided for all new residents. At the time of the inspection the Registered Manager said that the weekly fees were £399 up to £860 for continuing care and depending on individual care needs. There are additional costs for individual expenditure such as hairdressing, newspapers etc. Inspection reports regarding the home are available and can be accessed via the CSCI website: www.csci.org.uk. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. The site visit was unannounced and took place over six hours. We selected six residents (three residential and three nursing) and tracked the care they received through a review of their records, discussion with them (where possible), other people who use the service, visitors, the care staff, and observation of care practices. We spoke with staff members regarding training and support. Planning for the inspection included assessing notifications of significant events, a review of the Annual Quality Assurance Assessment (AQAA) sent to the CSCI by the service. Since the last inspection in February 2008 there has been a safeguarding investigation by the police, local authority, Health & Safety Executive (HSE) and CSCI. A person living at The Willows was believed to have climbed and fallen from a first floor window, sustaining significant injuries. It was concluded that this was an unforeseen event. The HSE has advised that the home fit additional window restrictors, which the home has done. The HSE was due to visit the home on 24th November 2008 to follow this up. Prior to the inspection surveys were sent to the service to residents, staff and health professional to provide feedback to the CSCI but none had been returned at the time of the inspection. The Registered Manager and other staff spoken with were positive and helpful during the inspection. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The Willows continues to provide a good standard of care. There is a rolling redecoration programme of fixtures and fittings. New armchairs have been purchased, some new vanity units fitted and some carpets replaced. One of the ground floor bedrooms was being redecorated and provided with new flooring and vanity unit during the last inspection. This has been completed and is now occupied. All areas of the home were fresh and clean. All hand basins, accessible to residents, now have thermostat valves to ensure that the water temperature is controlled and cannot scald the residents. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 8 What they could do better: 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. The summary of this inspection report can be made available in other formats on request. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 9 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 The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the home, and have their health and welfare care needs assessed, so that they can be met once they move into the home. EVIDENCE: The home provides prospective residents and their relatives with a Statement of Purpose and Service Users Guide (both give information about the home) to help them decide if the home is the right one for them. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 11 We spoke with residents about the information given to them about the home. Two residents spoken with said that either they or their relatives had been provided with information but others could not remember or were unsure. It was suggested that a copy of the Statement of Purpose, Service Users Guide and complaint procedure was provided for people in their rooms so that they had this information to hand. Copies of residents’ contracts are kept in the home in a separate file and residents, or their relatives, are provided with a copy. The six residents’ care plans reviewed contained an assessment by the placing authority; in the case of Northampton this also included a care plan. Either the Registered Manager or a senior nurse had undertaken an additional preadmission assessment to show that the home could meet the resident’s specific health and welfare care needs. It included personal details, relative and GP contact numbers, a past and present medical history, current health care requirements, medications, personal preferences, social interests and hobbies. However, there was little evidence to show that detailed social care information was obtained, and used in the development of a person centred care plan. The home does not provide intermediate care. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after in respect of their health and personal care needs. EVIDENCE: We looked at six care plans, three of people who were residential and three of people who required nursing care. Residents’ care plans gave nurses and carers information about the health and personal care needs of the residents. Some care plans had some person centred care information for example, the days of the week a lady changed her dress, and that she liked a daily bath with very minimal supervision. It was discussed with the Registered Manager and senior nurses that more work The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 13 needs to be done to implement person centred care plans that identify people’s individual care needs and meet their social expectations. Contact with healthcare professionals such as GP’s, District Nurses, hospitals, Podiatrists and Community Psychiatric Nurses (CPN’s) were recorded to ensure that healthcare needs and treatments were addressed. There were daily records for carers to complete to show that residents have received their identified care needs, such as bathing and oral hygiene. Care plans also reflected that residents with continence problems had toileting programmes in place and, where required, pressure care and continence management issues were discussed with the Tissue Viability Nurse to ensure that they were managed appropriately. However, we spent time in observing care in the lounge (known as 105). No one was taken to the toilet between 10:40 and 13:30, nor was anyone asked if they wished to go to the toilet. At 13:30 one lady became distressed, the carer suggested she might want to go to the toilet, but she wasnt taken. The lady then played dominoes with the activity organiser, then became tearful again and carer said theyd take her to the toilet. She was eventually taken to the toilet at 14:30. Staff should be more attuned to residents’ personal care and continence needs, thereby supporting continence and promoting residents’ dignity. It was also noted that one person sat in a chair in the lounge between 10:50 – 13:50. During this time the resident was not moved. His care plan stated that when in bed his position should be changed 2 hourly, but this did not happen whilst sitting in the chair. The resident was unable to move himself. This was discussed with Registered Manager and nursing staff during feedback. Appropriate risk assessment such as moving and handling, Waterlow pressure ulcer prevention and nutritional assessments were documented. All had been regularly reviewed, and care plans had been signed by the resident and/or their representatives to show that they were involved in and agreed with their personal plan of care. Medication policies and procedures were satisfactory. Medication Administration Records (MAR) were checked and had been completed correctly. Only trained nurses administer medication. A recent incident whereby a nurse had signed to say a medicine had been given, which was later found to be incorrect had been addressed by the Registered Manager. The nurse in question was being supervised and all of the nurses were receiving additional medication training via a home study course through Hinckley College to ensure that residents receive their medication safely and as prescribed. Observation during the inspection showed that staff had an awareness of how to protect residents privacy and dignity. For example carers supported The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 14 residents with regards to their dignity, using blankets over the ladies knees when hoisting. Staff spoke to residents and visitors in a respectful, friendly, quiet and supportive way. Residents, spoken with during the inspection, were mostly positive about the care and support they received. One person described the staff as ‘smashing kids’ and ‘very good people’. Another resident said that staff responded quickly at night if he rang his call bell and that staff were kind and caring. A relative said that they visited several times a week and were happy with the care their mum received. He said that the ‘Care was very good, I dont ask questions about her care’, and that ‘Staff are brilliant’. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people who use the service are not enabled to make choices about their lifestyle and how they spend their time. They have inadequate activities available to them on a daily basis. Meals provided meet the needs of people who live at the home. EVIDENCE: At the point of assessment information had been gathered with regards to activity favourites i.e. music, artist, author, etc. There was no evidence to show how this information was used to deliver or support person centred care even though the AQAA states ‘We use person centre care planning which is evaluated and updated when required (At least every 4 weeks): the care plans did not include a care plan for social interaction, stimulation, activities etc which were tailored to the individual resident’s needs. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 16 Care plans could be improved to provide a more rounded picture of what activities residents preferred, and responded to, especially for those residents with a degree of memory loss as identified at the last inspection in February 2008. Notice boards were in place, one providing information for residents regarding such things as library times and church services, and another that showed the photographs and names of the staff. There was a part time activities organiser who spent time with residents. In the afternoon she sat with a couple of residents and played dominoes and a board game and spent one to one time with a number of others. We made some general observation of daily life and care of residents who spent their morning in sitting in lounge 105 between 10:40 – 13:30 and for a short period during the afternoon and was discussed with the Registered Manager and senior nursing staff at the end of the inspection during feedback: The television was on at one end of the lounge. Residents sat in two rows, either side of the lounge, with minimal conversation or exchange between them. The television was only visible and audible to a few residents. Majority of residents during this time sat quietly, some sleeping with minimal communication and stimulation from carers. There were no activities in the morning with the exception of the television. At one point during the morning a member of staff walked through the lounge pushing a supermarket trolley, a member of staff said this was the moving of supplies i.e. tea bags etc., which could be quite confusing for persons with dementia. During the afternoon it was noted that carers in the lounge, engaged some residents in minimal conversation, about the weather and whether they wanted a drink etc. One person sat reading a joke book, and spoke with a carer about going out with friends that evening. A significant amount of time staff waited for the arrival of another member of staff so that they could take people to the toilet. This time could have been utilised by engaging residents in conversation or activities. One person’s choice of where she chose to sit when she came into the lounge was not supported. The carer then said, thats not your chair, you usually sit over there. At which point the lady got up and sat in another chair. Staff gave out biscuits with coffee, some residents were given a choice, and the staff handed them the biscuit, whilst in some instances the staff member chose, and handed the biscuit to the residents. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 17 All meals were prepared in the home’s kitchen by the cook. Meals arrived already plated, in a heated trolley. A cooked breakfast was available if required and residents could take their breakfast in their own room at a time to suit them. There were choices at all main meal times. Drinks were available throughout the day, coffee and biscuits in the morning and tea and home made cakes in the afternoon. Special diets such as diabetic and soft diets were catered for. Residents were weighed on admission, and regularly where necessary, and had a nutritional assessment in their care plan to ensure that their dietary needs were met. Staff were courteous and polite to residents, and offered assistance with eating and drinking. It was noted at the previous inspection in February 2008 that some residents chose to eat at individual tables that looked a little utilitarian (no table cloths/napkins etc). It was recommended that the Providers considered replacing the small tables used by residents at lunchtime and/or using tablecloths to improve the dining experience for the residents. However, the dining experience appears to remain unsatisfactory for some of the residents. Approximately ten people remained sitting in their comfy chairs for dinner. Tables in front of ‘comfy’ chairs were significantly higher than the chairs, whilst some people were able to sit forward others were slouched making it difficult to eat comfortably. One person was reclined in their comfy chair, and when staff placed his meal in front of him he couldnt see what he was eating as this was blocked from his vision by the plate guard. A nurse instructed a member of staff to turn the plate around, the plate guard was then effective allowing the person to feed himself and see what he was eating. Other residents who were in their rooms at lunch time were seen to struggle to eat their meals when laying down, had drinks left out of reach, and one person had been provided with spoons rather than a knife and fork to eat his meal. Three residents were fed by staff, staff did this on a one to one basis, sitting next to the residents, helping them in a discreet manner. One person who fed himself started eating his meal at 12:15, and finished it at 14:10. Carers did say that the gentleman preferred to feed himself. However, it would be worthwhile considering using a warming plate, to prevent the food from going cold. All residents spoken with said they got up and went to bed when they wished, were able to choose what they wanted for their meals, breakfast in their rooms if they wished, and were well supported by caring staff. Residents said that they were able to have visitors at any time and a number of people came to visit during the course of the inspection. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are satisfactory resulting in satisfactory protection of residents’ rights. EVIDENCE: The police, local authority, Health & Safety Executive (HSE) and CSCI since the last inspection in February 2008, have undertaken one safeguarding investigation. A person living at The Willows was believed to have climbed and fallen from a first floor window, sustaining significant injuries. It was concluded that this was an unforeseen event. The HSE has advised that the home fit additional window restrictors, which the home has done. The home’s complaints process reflects the local agreed procedures for Safeguarding Adults ‘No Secrets’ policies. Staff have been provided with appropriate training and minor issues are dealt with appropriately. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 19 We spoke with a relative of a resident who confirmed he had a copy of the complaints procedure, but that he did not have any complaint about the care. The care plan of another resident identified that they had an advocate through Age Concern and advice on advocacy was available to enable residents and their relatives to tell them how to obtain independent support if required. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comfortable, clean and satisfactory standard of accommodation is provided for the residents. EVIDENCE: The home was clean, and warm and maintained with adaptations to suit residents’ specific needs. It was decorated and furnished to a satisfactory standard that creates a comfortable environment for the residents. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 21 Many residents’ rooms have en-suite facilities, all have a ‘nurse call’, and were clean. Residents were able to bring items of their own furniture and possessions with them to personalise their rooms. The rooms seen were well personalised. The layout of the lounges with chairs lined up against the walls looks institutionalised and does not enable residents to communicate, only with the resident sitting on either side of them, and for some made watching or listening to the television difficult. There were sufficient additional lavatories, bathing and assisted bathing facilities. The home was comfortable and safe; risk assessments were in place where required in the files of the residents who were case tracked and the owners had responded in a timely fashion to the recommendation of the HSE to fit additional window restrictors to ensure that residents remain safe. The home was fresh and clean at the time of the site visit. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are well trained and sufficient in number to meet the residents’ needs. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 23 EVIDENCE: There were 44 residents at the time of the inspection. Staffing levels, at the point of inspection were sufficient to meet the current residents’ needs, with additional ancillary staff such as administrative staff, cooks and cleaners; there are always trained nurses on duty day and night. Since the last inspection staffing had been re-organised to ensure that an identified member of staff was in each lounge when residents were present. During the site visit, staff were present in the lounges, with only very short periods of absence. Residents and a relative said that there always seemed sufficient staff on duty. Three staff files were checked during the inspection and showed that there was a satisfactory recruitment process to ensure that residents were well protected. New staff carry out an induction programme and the Skills for Care induction booklet is currently being used for newly recruited care staff. Three of the senior nurses were Moving & Handling trainers and provided training for the staff, and staff receive mandatory, annual updates. The Registered Manager had introduced a training matrix to ensure all staff training needs were identified. Staff undertake training in specific areas such as fire training, first aid, moving and handling, food safety, infection control, and safeguarding adults and were able to show that they understood safeguarding procedures to ensure that residents were protected from harm. The Registered Provider said that about seventy-five percent of care staff had completed National Vocational Qualification (NVQ) in Care, Level 2/3 and that a number of other care staff had commenced NVQ’s. Staff at The Willows were well supported with their training needs: this and the training matrix ensures that staff have the necessary skills to give safe care to the residents. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager provides leadership to staff, ensuring that residents receive a satisfactory standard of care. EVIDENCE: The Registered Managers are first level nurses and work in a supervisory and management role in addition to the nursing and care staff numbers. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 25 The home conducts ongoing quality audits (satisfaction survey) for residents and relatives to complete. We recommend that the results be collated and actioned and written feedback provided in the Statement of Purpose and Service Users Guide (as indicated in the last two reports) to show that comments from residents and visitors help to improve the service. The Registered Manager said that this was in progress. Staff were supervised by the Registered Managers and senior nurses in performing their nursing and care tasks. Staff receive annual appraisals but supervision The implementation of the training matrix, and regular, recorded supervision makes sure that staff have their training needs identified and that they have the necessary skills to provide a good service for the residents. Health and Safety Policy and Procedures, such as regular recorded fire drills, fire alarm tests, and the recent installation of thermostatic valves to residents hand basins, and regular equipment maintenance showed that the Registered Managers were mindful of their responsibilities to make sure that residents live in a safe environment. The Willows Nursing & Residential Home DS0000001934.V372781.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP12 Regulation 16 (m) (n) Requirement Each resident should have a person centred care plan that reflects his or her personal requirements and social interests and demonstrates how these are being met. Timescale for action 05/01/09 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. Refer to Standard OP1 Good Practice Recommendations As people seemed unsure if they had received a Statement of Purpose, Service Users Guide and/or a copy of the complaints procedure it is recommended that these are provided for residents in their rooms. Staff should ensure that residents with an identified risk/need are assisted to move and be taken to the toilet regularly throughout the day in accordance with their care plan. People who choose to remain in their ‘comfy’ chairs or rooms at meal times should have individual tables DS0000001934.V372781.R01.S.doc Version 5.2 Page 28 2. OP8 3. OP15 The Willows Nursing & Residential Home 4. OP15 adjusted so that they can eat comfortably. Staff should ensure that plate guards are used correctly enabling people to see what they are eating and ensure that drinks are placed within easy reach at all times. The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 The Willows Nursing & Residential Home DS0000001934.V372781.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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