Care Home: The Willows Residential and Nursing Home

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What the care home does well When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must make sure for example, that they receive at least two references and carry out a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with vulnerable people. This had been done, all staff before being allowed to work had these checks made about them. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Activities in the home are also very good and staff have been working hard to increase the amount that is available to the people at the home. The company pay for people to visit and undertake a programme of activities, this includes exercise and quizzes. What has improved since the last inspection? There had been many changes and improvements made since the last inspection, these included: Improvements to the environment have been made. Most of the areas in the home have been re decorated. In addition new furniture has been purchased and in some areas carpets have been replaced. Numerous pictures had also been purchased that would suit a variety of different tastes and preferences and these were throughout the home. One person said,” I think it’s made a big difference, it just feels nicer to sit in here now”. Improvements have taken place in the home and the efforts of staff are now starting to show, several people commented on how improved the care at the home was. The way that staff write about the care in the home has also improved. Documents known as care plans had changed and they gave clear and simple guidance to staff in how a person should be supported. Some of these plans were very good especially one called ‘life wishes’. It described the persons wishes on how they should be cared for, where and when. This showed that people were still maintaining as much control over their own lives as possible. What the care home could do better: The home uses a system for managing medication that covers a 28 day period. Sometimes medication is left over for certain reasons into the next 28 day cycle. Staff had not always been entering the carried forward balance onto the new medication record. This means that you are not able to carryout an audit correctly. Senior staff had been doing medication checks, but not actual audits and this needs to change. You must be able to audit as this is the only way of knowing if people have been receiving their medication when they should. The system in place to notify staff that someone is ringing the doorbell needs to be reviewed. An alarm that goes off is not always heard by staff, so people can be left waiting for up to 10 to 15 minutes trying to get into the home.The Willows Residential and Nursing HomeDS0000071839.V376862.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE The Willows Residential and Nursing Home 73 Shakespeare Road Bedford Bedfordshire MK40 2DW Lead Inspector Katrina Derbyshire Key Unannounced Inspection 28th July 2009 11:00 DS0000071839.V376862.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 2 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 The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Willows Residential and Nursing Home Address 73 Shakespeare Road Bedford Bedfordshire MK40 2DW 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) 01234 268270 01234 273544 Hestia Healthcare Jennie Elizabeth Kent Care Home 31 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (31), Physical disability (31) of places The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Physical Disability - Code PD Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 31 15th July 2008 2. Date of last inspection Brief Description of the Service: There are 29 single and one shared bedroom in addition to a variety of communal rooms, including a visitor’s room. Bedrooms are decorated to individual taste and contain appropriate furniture People are encouraged to bring small personal items into the home. Larger pieces of furniture and small pets in cages are accommodated with prior discussion with the home. The weekly fees range from £507.06 to £685.00 per week dependent upon need. A copy of the last inspection report is available on the notice board in the front hallway for people using the service and visitors to access and read if they wish. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on the 28th July 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. Prior to the visit taking place the Care Quality Commission had sent to the home an Annual Quality Assurance Assessment (AQAA) for completion by the registered provider. This was returned prior to the visit and provided information on how the service self assess their own performance. During the visit we checked some of this information to make sure that what had been submitted was accurate. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The management’s submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. What the service does well: When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must make sure for example, that they receive at least two references and carry out a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with vulnerable people. This had been done, all staff before being allowed to work had these checks made about them. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 6 Activities in the home are also very good and staff have been working hard to increase the amount that is available to the people at the home. The company pay for people to visit and undertake a programme of activities, this includes exercise and quizzes. What has improved since the last inspection? What they could do better: The home uses a system for managing medication that covers a 28 day period. Sometimes medication is left over for certain reasons into the next 28 day cycle. Staff had not always been entering the carried forward balance onto the new medication record. This means that you are not able to carryout an audit correctly. Senior staff had been doing medication checks, but not actual audits and this needs to change. You must be able to audit as this is the only way of knowing if people have been receiving their medication when they should. The system in place to notify staff that someone is ringing the doorbell needs to be reviewed. An alarm that goes off is not always heard by staff, so people can be left waiting for up to 10 to 15 minutes trying to get into the home. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 7 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. The Willows Residential and Nursing Home DS0000071839.V376862.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 The Willows Residential and Nursing Home DS0000071839.V376862.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are sufficient to provide staff with an overview of each persons needs and indicate the individual care and support the person will need. EVIDENCE: A copy of the Statement of Purpose and the Service User Guide were examined, the documents in the main contained the details required to inform prospective residents on the management and staffing arrangements at the home and the range of services available. This assists people to make an informed choice as to whether the home can meet their needs. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 10 Each bedroom has a copy of the Service User Guide available for quick reference. However specific timescales need to be included on how long the service will take to respond to a complaint. Trial visits continue to be encouraged to enable prospective residents to look around the home and meet other people at the home. Within the care plans viewed there was records of pre admission assessments having been carried out prior to admission, the assessments had identified the range of peoples health, personal, spiritual and emotional needs. This resulted in a very clear picture of the individual needs of the person. Two people spoken with confirmed that they had been fully involved in their assessment; they had been given the opportunity to influence their own assessment. The Willows Residential and Nursing Home DS0000071839.V376862.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide the information needed by staff so that they are able to provide a consistent level of care and support. EVIDENCE: Care plans were seen to be up to date and sufficient in their content to guide staff in how they should support the person, all plans had been revised since the last inspection. Staff demonstrated that they had a good understanding of the needs of the people living at the home. People living in the home advised that they also had been given the opportunity to be involved in their care planning when this was possible and could sign them if appropriate. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 12 Everyone living at the home is registered with a General Practitioner. Everyone is assessed each month, or more often if the person is unwell for example. Tools that are used by staff in the home include Waterlow (pressure ulcer risk assessment) and MUST to identify if the person might be at risk of developing a pressure ulcer or becoming malnourished. The care plans and risk assessments identify who is at risk and what action is being taken to reduce the risk. In addition two people had plans written by the Nutrition and Dietetics Department at Bedford Hospital. People living at the home through discussion confirmed they received the medical support that they needed. Medication stocks were examined alongside the records relating to this area. The storage of medication was seen to meet national guidance in this area. Records of ordering medication were in place and provided the start of an audit trail. However two of the people looked at, had not had any balances carried forward, on calculating current stocks with the record it resulted in incorrect balances. The need to have to undertake audits at least monthly must be carried out, this will ensure that any failure is identified swiftly and action taken. Information supplied by the service showed that there is a visiting exercise teacher who does exercises with some of the people on a weekly basis. This person was actually visiting at the time of this ispection. They also provided a quiz and reminsence therapy. All residents are called by the name they choose, evidence in care records show that this is asked at the first point of contact with the person. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the 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 living at this home feel that the choice of meals provided are sufficient to meet their tastes and preferences. EVIDENCE: Activities in the home were noted to have improved in recent months. Several residents commented on varying things available to them. As described within the previous section, a visiting co coordinator was holding an exercise class at the time of this inspection. In addition reminsence and a quiz was held. Activities available in the home are on display so that people are kept informed of all events. Feedback from relatives and residents indicate that the home is supportive to both in maintaining contact, and involving families in the care of the residents. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 14 Information seen within the care records of residents contained entries and information to show that residents continued to make decisions in their lives examples included personal financial matters and voting. Menus available in the home show that a choice of food at mealtimes is offered that includes fruit and vegetables. One person said “ the dinners always taste nice” and several other people commented that they enjoyed their meals at the home. The staff were observed to ensure that individuals that required feeding in recliner chairs were sat upright in a comfortable position, all people were seen to be provided with drinks, and staff were observed to be recording the foods and drink intake. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the 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 assured that any complaints they may have will be listened to and acted upon. EVIDENCE: Since the last inspection visit four complaints had been received, records were available of the nature of the complaints, the investigations and the outcomes of the investigations. Responses to the complaints had been made in writing. There was records of meetings having taken place with the complainants to discuss their concerns the outcome of one meeting was to meet every four months to review the care plan. Since the last inspection two safeguarding referrals had been made, one of these was raised by the management in the home concerning financial matters to help protect a person living at the home, this did not relate to a risk from someone in the home. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 16 In discussion with the manager and staff it was confirmed that training has taken place on Safeguarding Adults, and from observations made during the visit the staff demonstrated that the rights of people using the service were respected. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the 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 general standard of the environment is good to provide an appropriate environment for everyone living at the home. EVIDENCE: Accommodation available to people is accessed by passenger lift. The furnishings, fittings and décor in these areas is of good standard, following re decoration, renewal of furniture and replacement of some carpeting. All residents who were seen spoke highly of their environment and felt that the home catered very well for their needs. Individual rooms contained personal items of the resident to assist in creating a homely atmosphere. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 18 All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment systems are good and protect the people living at the home. EVIDENCE: Within the staff recruitment files viewed there was records of pre employment checks having been carried out, which included police checks through the criminal records bureau (CRB) and the protection of vulnerable adults register (POVA first) as reported at the previous inspection. Professional references had been obtained and for staff employed from overseas and within the European community all checks had been translated into English. Training records submitted by the service showed staff had received training in moving and handling, SOVA, food hygiene and fire safety for example. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 20 People spoken to felt that staff would respond to them when they needed assistance. Everyone spoken with described feeling confident in their abilities and felt the owner and manager were especially friendly and courteous to them as they were always asking if they were alright. Observation showed that positive relationships had been established between the people living at the home and staff. Conversation flowed freely with engagement between them evidencing that this was a usual pattern as previously assessed. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people using the service, their health, safety and welfare is promoted and protected. EVIDENCE: Since the previous inspection the manager has become the Registered manager of the service. She is a Registered Nurse with 16 years experience of working with people who are aged 65 and over, and has achieved the The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 22 Registered Managers Award, an NVQ level 4 in care and a foundation degree in Care Management. Since the home has been taken over by the new owners the drive to improve on the standard of care has continued. Areas include redecoration, revision of care records and activities. The home seeks to hear the views of people using the service and their representatives by carrying out quality assurance surveys. The results of these were examined. The manager was observed to have good relationships with the people using the service, staff and visitors. Visitors spoken with were pleased with the care provided at the home as previously reported. No monies are held on behalf of anyone living at the home. The home has a Health and Safety policy. There was evidence within the training records that some staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments have been undertaken and were seen within the individual records examined. Records of the testing of water temperatures, fire equipment and electrical equipment were seen and noted to meet this standard. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 N/A X X 3 The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement A record of the actual balance of medication in the home must be accurate and include any balances that have been carried forward. This will enable audits to be carried out to make sure people are receiving their medication when they should. Timescale for action 30/09/09 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 Timescales for when the service will respond to complaints should be included within the statement of purpose and service user guide. This means people will know how long it will be until before they receive a response. The Willows Residential and Nursing Home DS0000071839.V376862.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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. 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