Care Home: Willett House Nursing Home

What the care home does well What has improved since the last inspection? The home has continued to improve standards of care provision within the home; the management has made a considerable investment in staff training and in personal development for staff; there have been significant improvements in the structure relating to supervision and appraisal systems. The quality assurance system continues to improve and the feed back from relatives meetings, staff meetings and the annual questionnaires reflect the improvements made in the home. The home has recently introduced protected mealtimes, making mealtimes a more social occasion making sure that the people who use the service feel comfortable at all times the contract caterers have reviewed the menus in consultation with the management and staff of the home; with a view to incorporating healthy eating initiatives. The home has also decided to organise weekly outings for the people who use the service albeit only to local venues relatives spoken to said what an improvement this made to their relatives quality of life it is hoped to expand this initiative; and the management of the home are making sure that relatives and service users are more involved in formulating and reviewing care plans, the changes needed to the care provided making sure that the persons changing care, health and social care needs are met appropriately. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Willett House Nursing Home Kemnal Road Chislehurst Kent BR7 6LT Lead Inspector Sue Meaker Key Unannounced Inspection 16th September 2008 10:00 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 Willett House Nursing Home DS0000010148.V371772.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. Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willett House Nursing Home Address Kemnal Road Chislehurst Kent BR7 6LT 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) 020 8402 8224 020 8325 5171 janet.chutto@missioncare.org.uk www.missioncare.org.uk Mission Care Mrs Moonwattie Janet Chuttoo Care Home 35 Category(ies) of Dementia (35) registration, with number of places Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category 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: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 35 Date of last inspection Brief Description of the Service: Willett House is a 32-bed purpose built home providing nursing care for people with dementia. Since May 2007, the home has registered three more single rooms bringing the total number of places available to thirty-five; these rooms have been incorporated on the first floor thereby making one unit for nine residents and one of ten. The ground floor provides accommodation for sixteen residents in two units of eight. The home is a two-storey building that is now able to provide thirty-one single bedrooms and two double bedrooms. The four units are semi independent each one having its own kitchenette, dining and lounge area plus the required number of toilets and bathrooms. A lift services the two floors. In addition, the home provides a large communal lounge used for a variety of activities and events, a hairdressing salon, a clinical room and a kitchen. There are gardens at the side and rear of the building and car parking to the front. The home is situated in a quiet residential area of Chislehurst close to shops and local bus routes Willett House Nursing Home DS0000010148.V371772.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 star. This means the people who use this service experience good quality outcomes. This was a statutory unannounced key inspection that required two days to complete; the inspection required a site visit of one day and another day to collate information from documentation received from the home at the site visit and time spent contacting relatives, healthcare professionals, and the Commissioners of care services for local authorities and local hospitals for their views about the care services provided by the home. An AQAA was received from the Home Manager, prior to the inspection taking place, this document was completed to a high standard and gave all the information requested. Currently there are thirty-four residents in the building with one vacancy Nine questionnaires were received from relatives of people using the service Discussions were held with the Operations Manager, the Home Manager, the Administrator, Maintenance person, the Chef and the trained nurses, care staff and domestic staff on duty at the time of the site visit. A tour of the home included observing lunch on all the four units in the home; inspecting the clinical room on the ground floor and observing the lunchtime administration of medication by the trained nurse, on the ground floor. Relatives and friends visiting the home were also asked for their views about the home, staff and services provided. Four resident’s files, four staff files and documentation relating to medication, staff training, health and safety, activities, finance, contracts, rotas and menus were inspected; information from all these areas has been used in compiling this report. What the service does well: Whilst visiting the home and undertaking a tour of the facilities, meeting the residents and speaking to relatives visiting the home it was evident that the residents were well cared for and that the relatives were happy with the standard of care provided by the staff at the home Comments made by the relatives visiting the home and via questionnaires included the following:• My mother and I are very well cared for in all ways. • Very good nursing care. • The home manager and her staff are very co-operative and helpful. • This home is the best throughout the borough; everyone of the staff works beyond the call of duty. Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 6 • • • • I feel that I can safely leave my relative in the home in the knowledge that the management and staff of the home are committed to providing the very best care. I feel involved in the care of my relative and am consulted about all aspects of the care provided. My relative is very happy here and has settled down extremely well it is one of the best homes specifically catering for the needs of those with dementia. The staff understand how to treated people with dementia appropriately Staff spoken to said that they felt supported and encouraged by the management of the home: newly employed staff stated that they were on a thorough induction programme that they needed to complete prior to undertaking their NVQ 2 in care. Staff stated that they received regular supervision and an annual appraisal’ during these meetings their training needs were discussed and appropriate training courses were identified for them. What has improved since the last inspection? What they could do better: The home is intending to do the following to improve facilities offered by the home:• Make improvements to th way staff are recruited and look at how they Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 7 • • • • • • • can be retained by effective training and promotional prospects. To encourage relationships with the local community Having a user focus by view care and services through the eyes of our users and carers Safety by seeking to protect ours users, staff, relatives and public from harm Being responsive by acting immediately and avoid unnecessary delays for intervention and treatment Learning by constently reviewing, updating, and improve our practice and services Excellence by not setteling for second best Partnership by working with other agencies to ensure our residents have the best help and value for money 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. Willett House Nursing Home DS0000010148.V371772.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 Willett House Nursing Home DS0000010148.V371772.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families receive information about the home, so they are able to make an informed decision as to whether their assessed personal, health and social care needs can be met. All residents have a contract giving the terms and conditions of their residency. Prospective residents and their families are encouraged to visit the home to ascertain its suitability to meet their specific assessed care needs. Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home’s Statement of Purpose provides comprehensive information relating to their philosophy of care, the mission statement, the contract, the complaints policy and procedure, details of the building, a brochure containing all the information about the home, the organisation and the services the prospective residents can expect. This is a very informative document and complements the Service User Guide, a copy of which is given to the family of all people who use the service. Relatives surveyed and spoken to (on the day of the site visit) confirm that they had received information from their local social services or hospital and had contacted the home for further information. All residents have a copy of their contract; the original one is kept on their personal files, detailing the terms and conditions of their residency including the responsibilities of the organisation, details of the contract and services provided, general terms giving specific room number and fee payable, the residents responsibility, repairs and maintenance and consultation and communication, this contract is signed and witnessed by the resident and the organisation. This was evidenced by contracts seen on the residents’ personal files that were kept in a locked filing cabinet in the administrator’s office. From the information given in the AQAA it is evident that the home has a robust pre-admission process; a trained nurse completes a nursing history assessment form in consultation with the prospective resident and their family if appropriate. At this stage the prospective resident and their family are encouraged to visit the home and a advance care plan is discussed and formulated thereby making sure that the care provided is in keeping with the needs and preferences of residents and their carers; this document is used as a guide and is a record of what the resident wishes to happen when receiving personal, health and social care. A key worker is identified for the prospective resident and will gather information by asking appropriate questions enabling the team at the home to establish whether they can meet the assessed personal, health and social care needs of the prospective resident, and whether the home is the appropriate placement for the person. Four residents files were inspected and found to contain a pre-admission assessment of personal, health and social care needs, there was evidence of input from family and healthcare professionals; files contained assessments of need from either local social services or local hospital. All files contained a copy of a letter sent by the home manager to say that the prospective residents’ needs could be met. Relatives surveyed and spoken to at the time Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 11 of the inspection confirmed that they received enough information about the home so that they were able to make an informed decision as to whether the home could met the personal, health and social care needs of their relative. They also stated that they felt that the home successfully met their relative’s needs and that the home helped them keep in touch with their relative. Please note that Standard 6 is not applicable to this home. Willett House Nursing Home DS0000010148.V371772.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans inspected reflected the personal, health and social care needs of the residents; they incorporated information from the resident, their family and healthcare professionals, enabling care staff to provide care to their wishes and preferences, thereby respecting their right to choice, dignity and privacy. EVIDENCE: Four care plans were looked at in detail on the day of the inspection, feedback was also obtained from the home manager and staff in respect of the completion of care plans. The care plans seen confirmed that there had been input from the resident’s family and friends and healthcare professionals. The care plans were personalised to the individual resident and identified their specific personal, health and social care needs and gave specific ways in which this needs were met respecting the independence, privacy and dignity of the individual being cared for in the home. The care plans also included risk Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 13 assessments relating to moving and handling, mobility, cot sides, challenging behaviour and dementia. There were care plans relating to activities and how the residents social care needs were being met. All residents had a monthly review the outcomes were documented and signed by those present; care plans were updated as part of this review process. The home has a very good relationship with their GP, who holds a weekly surgery at the home; the GP is happy to access appropriate services from other healthcare professionals, these services included referrals to the hospital consultants, psycho-geriatricians, psychiatrists and physiotherapists as well as the district nurses and the tissue viability nurse. The home was able to access optical, dental and podiatry services for the residents as and when required. Relatives spoken to said that they were happy with the services provided by the home and that they felt their relative was well looked after, one relative said they were kept informed of referrals made, of hospital visits and admissions to hospital; relatives surveyed felt that the staff had the experience, skills and competency to care for their relative. The clinical room on the ground floor was inspected and the medication file for the ground floor was checked. The organisation has good policies and procedures relating to the safe administration of medication, copies of these policies and procedures were available as part of the medication files. The home operates a nomad system for the administration of medication, and medication is only given by the trained nurse on duty, the MARS sheets all have an up to date photograph of the resident and is computerised, the MARS sheets were completed accurately and all medication given was signed for correctly. The clinical room was well organised and clean and tidy; the food supplements checked were stored correctly and were within date; an accredited contractor collects unused drugs and sharps once a month. Fridge temperatures were checked and were accurate. Staff received training in the safe administration of medication from the local Primary Care Trust; staff spoken to confirmed that they had received training and the training files inspected also evidenced that this training had been given. During a tour of the home it was obvious that the staff cared about their residents’ there was an established rapport between them; the staff spoke to the residents respectfully being mindful of their right privacy, dignity and independence. Relatives spoken to confirmed that the staff were easy to talk to and would do anything for their relative; that they felt comfortable and trusted the staff with all aspects of their relative’s personal, health and social care. The management and staff at the home are aware of their responsibilities relating to the Data Protection Act and are trained to deal discreetly with the Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 14 affairs of the residents and were aware of the need to maintain confidentiality on behalf of the residents in their care; making sure that the residents are aware of the information held about them and how it is used, how they can access it enabling them to maintain their legal, civic and political rights. Since the last inspection the home has fully implemented the Gold Standard Framework – End of Life Care, one of the trained nurses is the clinical lead for this and the home is accredited by the Gold standard Framework organisation. An individual care plan relating to end of life care is developed with the person who uses the service (if appropriate), the family, the management and staff of the home and the homes’ GP; the relevant paperwork is completed and filed in the resident’s personal file; a protocol is then put in place giving the correct procedure to follow in the event of the death of the resident. Willett House Nursing Home DS0000010148.V371772.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home endeavours to provide appropriate activities to the residents supporting and encouraging them to maintain their chosen lifestyle in a residential care home environment. The residents are provided with a nutritious and healthy menu ensuring that they maintain a healthy diet. EVIDENCE: The home endeavours to provide appropriate activities for the people who use their service, unfortunately the activities co-ordinator has left and the home manager is in the process of recruiting a replacement; currently it falls to the staff in the home to implement the activity programme. The residents appear to enjoy the range of activities on offer in the home; there are activity care Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 16 plans for each unit and these are implemented on a daily basis subject to the needs of the group of residents. The activity co-ordinator had put together an information file giving details of all the things the residents had done or been a part of, from arts and crafts, reminiscence, gentle exercise, hand massage and nail care to musical and film afternoons, gardening, going out for walks and church services. The activity programme was seen and the home has a designated space within the home for activities. The space is used for arts and crafts, musical entertainment, gentle exercise and massage, watching films and playing board games. It was evident from speaking to the home manager and staff on duty that they are aware of the special social needs of the residents, and the home manager has been giving the staff specialised training in undertaking and accessing appropriate activities for those with dementia and challenging behaviour. The Home Manager said that she is continuing with the compilation of life history books for each resident, this isbeing done in conjunction with the family and friends of residents to build a picture of their life prior to coming into the home. Relatives, friends and local community groups are encouraged to visit the home; relatives surveyed and spoken to agreed that the staff in the home made them feel welcome whenever they visited, there was always someone available if they needed to discuss any concern they had and that they felt involved in the daily life of their relative; there were regular relative meetings and the minutes of the meetings seen confirmed that they are well attended and that relatives had a considerable input into arranging social events in the home and that they were very supportive of the home in this area. In May 2008 four of the more able residents went to Butlins in Bognor Regis, for the weekend, four members of staff and a family member accompanied the residents and a good time was had by all- the photographs seen showed that the residents had really enjoyed themselves; the home manager and staff are organising more outings to the local area and this has been a real winner with the people who use the service and their families, these outings have included visits to local pus, restaurants, shops and parks. The home manager is in the process of accessing arts and crafts and music appreciation via the local Adult Education College. Residents in the home are unable to manage their own financial affairs, this is undertaken by their relatives; the home is also able to provide information about local advocacy service for those residents who do not have anyone to help them with financial matters. The service user guide states that the home manager would be able to arrange for pensions to be collected and a savings account to be set up. All such arrangements are established and accounted properly by the homes’ administrator and overseen and audited by the home manager. Residents and their families are encouraged to personalise their bedrooms by bringing in small items of furniture, televisions, radios or music centres along with personal photographs, pictures ornaments. The organisation is happy for relatives to decorate rooms as they wish and to provide their own soft furnishings such as bed linen and cushions; a record is kept by the home of all the resident’s personal belongings. Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 17 Meals in the home are provided by a contract caterer; the kitchen was clean, tidy and well organised, the kitchen had recently had an inspection by the local authority Environmental Health Officer and the kitchen’s Clean Food Award was renewed. It was noted that all appropriate records were kept relating to fridge and freezer temperatures, hot and cold food temperatures HACCUP documentation and the kitchen had cleaning schedules in place and documentation in place to show that cleaning was undertaken. The menus seen provide a range of appetising, nutritious, healthy and well balanced food; there is also an alternative choice to the daily menu where residents are able to choose from jacket potatoes, fresh salads, omelettes and sandwiches; hot and cold drinks, biscuits and cakes being available at all times. The kitchen is also able to cater for special diets. Since the last inspection the menus have been reviewed and the people who use the service and their relatives have been involved in this process, the menus now reflect the religious preferences of the resident. Lunch was observed on most of the units two staff were serving the meals from a hot trolley, one resident was being assisted to eat by her daughter, who said that she thought the food was good and that her mother enjoyed her meals, one resident was able to say that she thought the meals were fine and she particularly liked her rice pudding; the two staff members were encouraging and assisting residents who required help to eat their meals, this was being done in a sensitive and compassionate manner and as unobtrusively as possible. The atmosphere in the dining areas was calm and peaceful with residents enjoying their meal in pleasant surroundings. Willett House Nursing Home DS0000010148.V371772.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to feel safe and protected in the home due to the homes’ policies and procedures and staff training relating to complaints and the Protection of Vulnerable Adults EVIDENCE: The organisation has robust policies and procedures in place relating to complaints, this document is to be found in the service user guide and in the homes’ statement of purpose and it is also displayed in the entrance hall of the home. From the surveys received and from chatting to relatives visiting the home at the time of the inspection; it was evident that they were aware of the complaints procedure and knew how to instigate it if necessary. Those surveyed and spoken to said that if they were not happy or if they had any concerns they would refer them to the nurses and the management of the home, they said that they felt confident that their issues would be dealt with appropriately and resolved quickly to their satisfaction. The home has a complaints log and records all the details of any complaint received, from the acknowledgement of the complaint, through the investigation to the outcome and resolution. The AQAA also confirms that a record is kept of all complaints and that the home manager informs the complainant at all stages of the Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 19 investigation and of the outcome. On inspecting the complaints log it was evident that complaints had been dealt with complying with the organisations complaints policy and procedure; since the last inspection it has not been necessary for the home manager to refer any complaints to the complaints to the CSCI or been investigated under POVA. All of the staff have undertaken training in the Protection of Vulnerable Adults, this is an ongoing process and there was evidence that further training has been booked. The training has been accessed via the Local Authority Social Services through the Care Home Training Consortium. Staff received training in adult abuse during the induction process and as part of their NVQ 2 course. Staff had access to the homes’ policy and procedure relating to the Protection of Vulnerable Adults and the “Whistle-blowing”. The staff spoken to confirmed that they were aware of POVA and the different forms of abuse they also confirmed that they had attended specialist training relating to POVA and their training profiles showed evidence of specialist training courses relating to the Protection of Vulnerable Adults, training as part of the induction and NVQ process. The home has a copy of the Local Authority Multi Agency Protection of Vulnerable Adults guidelines and policy and procedure. Willett House Nursing Home DS0000010148.V371772.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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean and hygienic, well maintained, well equipped and comfortable home, making sure that the layout and design of the home encourages and supports resident’s independence. EVIDENCE: The home is maintained to a good standard, the organisation now employs a Group Maintenance Manager, requests for repairs and planned decoration and maintenance are made via email and a maintenance person is sent to the home to complete the task. There is now an annual maintenance and programme for the group rather than for each home; there is also an ongoing Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 21 redecoration and refurbishment programme formulated in conjunction with home managers, the area manager and the group maintenance manager. The home is divided into four self contained units each with its own dining area, lounge and fitted kitchen with the benefit of a dishwasher. The four units are decorated and furnished to a good standard; the home also has a larger lounge on the ground floor used for activities, meetings and social events and the home benefits from a well-kept garden including a patio area, a greenhouse and vegetable garden. The home has a passenger lift to the first floor, which can also be accessed via a staircase. Each of the four units have bathrooms and toilets easily accessible for the residents; toilets which are fitted with raised toilet seats and grab rails and baths fitted with hoists; toilets and bathrooms could also be accessed by wheelchair users. Resident’s bedrooms seen were all fitted with wash hand basins and some were en-suite. During a tour of the home some of the bedrooms were seen, they were personalised having items of furniture, ornaments, pictures, televisions, music centres and radios; residents families are encouraged to have input into the decoration and furnishing of their bedrooms. The bedrooms seen were decorated and furnished to a good standard; the carpets had been replaced with new flooring more suited to the residents; this change was implemented after consultation with relatives. The home does not have its own laundry, this is done centrally at another home within the group; however this does seem to cause a few problems with unmarked clothing and can often lead to complaints from relatives; during the inspection laundry was delivered to the home; clothing and bed linen seen were laundered to a good standard and looked to be in good repair. The home provided clean, pleasant and hygienic surroundings for residents, relatives and visitors. Willett House Nursing Home DS0000010148.V371772.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures that all staff are trained in order to have the skills and competency necessary to meet the personal, health and social care needs of the residents in their care; this outcome is achieved by implementing thorough recruitment, selection and training policies and procedures. EVIDENCE: The rotas seen confirmed that there was sufficient staff on duty at any one time to meet the assessed personal, health and social care needs of the individual residents. Residents spoken to said that there was always a member of staff around to help them when needed and the relatives’ surveys confirmed that they felt the care staff had the right skills and experience to look after their relative properly, that they gave the support and care that had been expected and agreed in the care plan and that the staff supported the residents to live the life they chose. The organisation has policies and procedures in place to make sure that staff are recruited in line with the regulations. Personnel records showed that staff had completed an application form, were interviewed, provided two references and completed the documentation for the CRB check, staff were also referred Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 23 for a POVA check and the pin numbers of trained nurses were all check and confirmed prior to the prospective member of staff being offered employment with the organisation. Four personnel files were inspected, the files seen contained the information required by Schedule 2 of the National Minimum Standards; and therefore complying with regulation 19 of the Care Standards 2000. Personnel files also evidenced that staff had undertaken an induction programme in line with “Skills for Care”, successful completion of this programme enabling staff to be put forward for an NVQ 2 qualification in care. The personnel files also showed that staff received supervision on a regular basis; and completed an annual appraisal. Staff interviewed confirmed that they received support and encouragement from the organisation particularly relating to training opportunities and that the supervision and appraisal system, and staff meetings gave them a forum to discuss their views about the home, their residents care, any employment issues they might have and their prospects for advancement within the organisation. The home has a good programme of training on offer, and bases the annual training plan around training available from the local authority “Care Home Training Consortium”; this organisation offers specialist dementia and challenging behaviour training as well as understanding older people, loss and bereavement, customer care, diet and nutrition in older people, autism in older people, equality and diversity, supervision skills, managing challenging behaviour and report writing. The home manager has now instituted” in house” training relating to fire safety, moving and handling, first aid, food hygiene, POVA, infection control, pressure area care and personal care. Training records were seen confirmed that staff had attended training courses offered by the consortium along with applications made on behalf of staff for the training, the files also included evidence that staff had attended in house training given by the home manager and invited external trainers. Willett House Nursing Home DS0000010148.V371772.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, 32, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is competent, qualified and experienced, and manages the home to a high standard, she operates an open door policy for the people who use the service, their relatives and her staff. The home has effective and efficient management and administration systems in place to ensure the best interests and health and safety of the residents and staff; management make sure that the administration systems ensure the home is financially viable. The home is continuing to develop their quality assurance system, enabling them to monitor the quality of service provision. Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has a competent and experienced manager who is supported by a committed staff team. The home manager is a qualified RMN, and has achieved NVQ 4 in Management and the Registered Managers Award. The home manger understands the philosophy of the home and is able to meet its aims and objectives as set out in the Statement of Purpose. From questionnaires received and from speaking to relatives it was evident that they felt that the management and staff at the home were approachable, friendly, helpful, willing to listen, compassionate and sensitive to individual needs. They also said that any concerns they raised were dealt with in a sensitive and compassionate manner and resolved quickly with the minimum amount of fuss and that there were always members of management around and accessible. The Operations manager has the responsibility for conducting the regulation 26 visits to the home required by the CSCI and sends copies of the report to the CSCI. The Home Manager is responsible for implementing the quality assurance documentation for the home, an annual survey of the service provision is undertaken, the homes’ administrator sends out questionnaires to relatives, staff, healthcare professionals and social services to ask their opinion of the services they provide. The home holds a regular relatives meetings, that are attended by the operations manager as well as the home manager, there is also input from the contract caterers employed by the home; these meetings are well attended by relatives as shown by the minutes of the meetings seen. An annual survey was carried out in May 2008 the results were very positive and the following results were achieved:71.4 said that the environment was excellent 28.6 said it was good. 42.2 said the food and meals were excellent. 57.1 said they were good. 50.0 said the quality of care was excellent 5o.0 said it was good. 21.4 said the social activities were excellent 57.1 said they were good. The relatives survey was undertaken in March 2008 with 12 relatives being satisfied with the home overall, four were satisfied and one fairly satisfied. Nineteen relatives stated that they would recommend the home, and eighteen relatives said they would use the home again if it was necessary. The home also undertakes extensive audits to make sure that standards within the home are closely monitored and therefore maintained to a high level; Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 26 these audits include;- medication, care plans, food and meals, fire, health and safety and a weekly audit of the residents rooms. Currently the home does not act as appointees for any of their residents however they do support some residents by holding cash for them. Receipts are kept for all financial transactions; receipts are given for any monies received from relatives and the administrator keeps individual accounts. Documentation relating to the policies and procedures of the home, set by the organisation, were inspected and found to comply with regulations and there is written evidence to show that these documents are reviewed annually; the documents themselves are signed and dated thereby evidencing that they are current. From information given in the AQAA it was evident that the home has an approved fire risk assessment in place; it was evident from inspecting the Fire File and from speaking to the homes’ maintenance person that the fire alarms, fire fighting equipment, fire drills and fire training are completed and recorded in accordance with the organisation’s policies and procedures. The temperature of water was checked and recorded each month. Health and Safety certificates were in date and therefore complied with relevant current legislation detailed in the National Minimum Standards – Care Homes Regulations 2000. . Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 27 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 4 3 3 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 4 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 4 X 3 X 3 4 Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Willett House Nursing Home DS0000010148.V371772.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Willett House Nursing Home DS0000010148.V371772.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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