Care Home: Willow Brook House

What the care home does well Observations made during the inspection showed that staff had a good understanding of people`s needs and how to care for and support people. Interactions between staff and people living in the home showed good rapport and a respect for people`s preferences. Staff were seen assisting people with their lunch in a sensitive manner. One person told us the ""food is terrific". What has improved since the last inspection? The needs of people living at the home have been reassessed. Assessments seen were comprehensive and looked at people`s full range of needs. Staff told us that they were in the process of re-writing care plans for everyone to ensure that they contained all of the information needed to care for people in the right way. Pen pictures are being developed for each of the people living in the home. These are kept inside people`s wardrobe doors and ensure that the key information that staff need to care for the person in the right way is easily accessible. Improvements have been made to the medication procedures to ensure that all prescribed medication is available in the home. The entrance to the lower ground floor has been made welcoming with new curtains in the stairwell and new signage. Photographs are used on people`s bedroom doors to help people with dementia identify their own bedrooms. What the care home could do better: Assessments and care plans need to be reviewed regularly as people`s needs change. Some signatures were missing from the medication administration record for one person who has prescription creams. The medication profile for one person had not been updated to reflect a change in their medication. Details of when one person had had their medication reviewed was not available. The medication administration record for one person recorded that they had been given an incorrect dose of medication. It was not established during the inspection whether this was a recording error or an error in the administration of medication. The error had not been noted by the home. A range of activities should be made available which reflects the interests, preferences and abilities of all the people living in the home. The home was generally clean but a slight unpleasant odour was noted on the lower ground floor. We discussed with the manager the need to sustain and consolidate the improvements that have been made within the home. Key inspection report Care homes for older people Name: Address: Willow Brook House 77 South Road Corby Northants NN17 2XD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 0 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Willow Brook House 77 South Road Corby Northants NN17 2XD 01536260940 01536260941 willowbrookhouse@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 48 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: No person falling within the DE(E) category can be admitted where there are 23 people of the DE(E) category already in the home. No person falling within the OP category can be admitted where there are 25 people of the OP category already in the home. No person falling within the PD(E) category can be admitted where there are 25 people of the PD(E) category already in the home. The total number of Service Users in the home must not exceed 48. Date of last inspection Brief description of the care home Willow Brook House is a care home providing personal care and accommodation to forty eight older people over the age of sixty five years. Up to twenty five people may have a physical disability and up to twenty three people may have dementia. The registered provider is Ashbourne Eton Ltd, which is owned by Southern Cross Care Homes for Older People Page 4 of 24 0 0 0 Over 65 23 25 25 Brief description of the care home Healthcare. Willow Brook House is a purpose built facility located in the Old Village area of Corby Northampton, with local community shops nearby. There are two floors; residents with dementia are located on the lower floor and residents with a physical disability on the upper floor. All bedrooms are for single occupancy and have en-suite facilities. There are 23 bedrooms on the lower floor and 25 bedrooms on the top floor. Communal dining rooms, lounges and bathrooms are located on both floors. The following fees were detailed in the scale of fees provided as being current at the time of inspection Private General Residential Customer GBP627.00 Private Dementia Customer GBP627.00 LAHA funded General Residential Customer GBP355.21 LAHA funded Dementia Customer GBP381.63 Local AuthorityHealth Care funded customers are accepted on the expected to pay rates above. In addition a request is made for a GBP20 third party top up, which is set at the discretion of the manager. The fees include personal care, accommodation, meals and laundry. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include personal expenditure such as newspapers, clothing and toiletries. Information about the service including the most recent inspection report is available in the foyer. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for people using the service. As part of the preparation for this inspection a period of six hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection. This included: The previous annual quality assurance assessment (AQAA) that was sent to us by the Care Homes for Older People Page 6 of 24 service in September, 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The action plans sent to us by the home on a regular basis detailing actions taken to address the issues raised at our last key inspection. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection carried out in September 2009. The random inspection conducted in December 2009 to check compliance with a statutory requirement notice served following the key inspection in September 2009. Relevant information from other organisations. The inspection visit lasted eight hours during the morning and afternoon of a weekday. During the inspection two people were case tracked. This involves looking in detail at all aspects of their care and experiences at Willow Brook, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered manager was present for the inspection. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: Assessments and care plans need to be reviewed regularly as peoples needs change. Some signatures were missing from the medication administration record for one person who has prescription creams. The medication profile for one person had not been updated to reflect a change in their medication. Details of when one person had had their medication reviewed was not available. The medication administration record for one person recorded that they had been given an incorrect dose of medication. It was not established during the inspection whether this was a recording error or an error in the administration of medication. The error had not been noted by the home. A range of activities should be made available which reflects the interests, preferences and abilities of all the people living in the home. The home was generally clean but a slight unpleasant odour was noted on the lower Care Homes for Older People Page 8 of 24 ground floor. We discussed with the manager the need to sustain and consolidate the improvements that have been made within the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is available for prospective people who may want to move to the home. Evidence: The home has a statement of purpose and service user guide which give people good information about the home and the services it offers. The statement of purpose and service user are used in the admission process, to give information to prospective people coming into the home. A note on the front of the service user guide states that it is available in other formats such as large print on request. At the time of this inspection no new admissions to the service were being made. Northamptonshire County Council were not making any placements as a result of their policy not to admit to services with a zero star rating. Southern Cross Healthcare had agreed that they would not take any new admissions until improvements had been made. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are being generally well met but staff may not always have all the information about peoples needs and preferences because assessments and care plans are not being reviewed and updated appropriately. Evidence: Since the last key inspection in September 2009 records show that the needs of people living at the home have been reassessed. Assessments seen were comprehensive and looked at peoples full range of needs. Staff told us that they were in the process of re-writing care plans for everyone to ensure that they contain all of the information needed to care for people in the right way. Staff explained that they have been working extra hours to ensure that everybodys care plans are updated. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, culture and religion, health and continence and contained good information about peoples needs and preferences with clear instructions to staff about what they needed to do to meet peoples needs. Care Homes for Older People Page 12 of 24 Evidence: The manager explained that pen pictures are being developed for each of the people living in the home. The pen picture for one of the people we case tracked was inside their wardrobe door. Pen pictures contain the key information that staff need to care for the person in the right way, this ensures that all staff can access this information easily. Although peoples care plans and assessments were being rewritten there was limited evidence that they were being reviewed on a regular basis. A requirement made at the last inspection stated that assessments needed to be reviewed at least monthly and as and when circumstances or needs change. The assessment and care plans for one of the people we case tracked had been written in November 2009 but there was no record of them being reviewed since that time. The nutritional risk assessment for one person had not been completed since November 2009. There was no record in the persons file to show that their weight was being monitored, despite previous assessment indicating high risk of malnutrition. Staff stated that this person had been weighed regularly and had actually put on weight but this information had not yet been recorded in their file but that it was recorded elsewhere. Having information such as someones weight record accessible is important to ensure that it can be monitored and appropriate action taken as required to meet the persons needs. Records show that people had been assessed to find out if they are at risk of developing pressure sores. Where it was identified that there was a risk measures were put in place to reduce the risk such as provision of specialist equipment and helping people to change position regularly. The administration of medication is generally well managed. A record of medication delivered to the home, along with any medication returned, was viewed. Staff told us that medication for people was being delivered on time and, were there to be any delays, arrangements would be made for someone to go out and collect the medication to ensure that people living in the home were not without prescribed medication. The manager explained that senior staff check the medication every Wednesday to ensure that each person living in the home has at least seven days supply of prescribed medication. Some signatures were noted to be missing from the medication administration record for one person who has prescribed creams. Staff explained that the creams in question are administered to the person in their bedroom so the home planned to put signing sheets in place in the persons room to ensure that staff signed to show that the Care Homes for Older People Page 13 of 24 Evidence: creams were being administered as prescribed. The medication profile for one person showed that they were taking co-codamol. Staff told us that this medication had been stopped and the person was now prescribed paracetamol but that the medication profile had not been updated. Staff told us that people have their medication reviewed on an annual basis around the time of their birthday. The record for one person to show when they had last had their medication reviewed was not available, staff explained that it had been archived. Records for one person, whose medication dose changes frequently in response to the results of regular monitoring, recorded that they had been given a slightly lower dose of medication than was prescribed. It was not established during the inspection whether this was a recording error or whether the person had been given the wrong dose of medication. This error had not been noted by the home. At the time of inspection a new storage area was being fitted out to accomadate the storage of medication on the ground floor. Care Homes for Older People Page 14 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sensitive staff support ensures that people enjoy the food served within the home. Evidence: Lunch was observed during the inspection. Staff were seen assisting people in sensitive manner, talking to them and explaining what the food was. People told us that the food was good. One person said that the food is terrific Some people chose not to go to the dining room at lunchtime. It was noted that where these people needed assistance with their meal that staff sat with them in their bedrooms to ensure that they received the appropriate help. One member of staff told us about the advice she had been given by the companys dignity adviser on how to help people with their meals. The home employs an activities coordinator. On the day of inspection she was seen spending time talking to people and doing manicures for people, although not everybody was involved in these activities. People were observed watching television, listening to music and singing. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded from harm by the homes policies and procedures and good staff awareness. Evidence: Staff spoken to had a good knowledge of how to safeguard adults and their responsibilities under the locally agreed procedures. The home has made one referral to the local authority under the safeguarding adults procedure. The home have not made any applications to the Local Authority under the deprivation of liberty safeguards and observations made during the inspection suggest that people are able to move around the home freely and do not have any restrictions placed on them. The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. Records show that concerns raised are investigated by the home in line with this procedure. Three complaints have been recorded since the last key inspection. Information about local advocacy groups is in display by the main entrance of the home. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Standard of the environment meets the needs of the people living in the home, providing a safe and comfortable place to live. Evidence: Willow Brook is a large purpose built establishment consisting of two separate floors. The lower ground floor accommodates people with dementia. The entrance to the lower ground floor has been made welcoming with new curtains in the stairwell and new signage. Both floors have lounge and dining areas, bathrooms and bedrooms. All bedrooms are single en suite. People told us that the lounge on the lower ground floor had been redecorated and new blinds purchased for the conservatory area. The manager told us that the corridors on this floor were going to be redecorated. People told us that they were able to personalise their bedrooms with their own items and personal effects. The manager explained that photographs are used on peoples bedroom doors to help people with dementia identify their own bedrooms. The home was generally clean but a slight unpleasant odour was noted on the lower ground floor. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being cared for by a caring staff team who have a good awareness of their needs and preferences. Evidence: The recruitment of staff is well managed with all of the necessary pre recruitment checks being carried out to ensure that staff are suitable to work with older people. Staff told us that they had an induction when they first started working at the home which included working alongside an experienced colleague to make sure that they had all of the information that they need to do their job in the right way. Staff explained that they attend training courses such as food hygiene, safeguarding of adults, dementia care, infection control, fire safety and moving and handling. Observations made during the inspection showed that staff had a good understanding of peoples needs and how to care for and support people. Interactions between staff and people living in the home showed good rapport and a respect for peoples preferences. Staff told us that they had been working hard to update peoples peoples care plans and that the standard of care in the home was improving. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home has led to improvements being made which now need to be sustained. Evidence: The manager told us that he is in the process of registering with the Care Quality Commission to become the registered manager for the home. It is a legal requirement for the home to have a registered manager. The home has not conducted any satisfaction surveys since the last inspection. The manager explained that individual meetings were held with all of the people who live in the home and their relatives to discuss the running of the home and to request feedback from people. Following these monthly meetings have been held which people living in the home and their relatives can attend. The manager stated that at the meeting in November 2009 a number of concerns were raised about the home but that subsequent meetings have been increasingly positive. Minutes to these meetings show that they are attended by the catering and domestic staff and the maintenance Care Homes for Older People Page 19 of 24 Evidence: person to ensure that people are able to give feedback directly to the people responsible for these areas. At the random inspection carried out in December 2009 it was noted that their had been improvements made in the areas highlighted by the last key inspection carried out in September, 2009. Some further improvements were noted during this inspection and have been detailed within this report. We discussed with the manager the need to sustain this improvement. A sample of the safety checks conducted by the home, such as fire checks, checks on the water system and portable appliance testing showed these checks to be up to date. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The medication administration record must be completed to show that all prescribed medication including creams are administered as prescribed. To ensure that people receive all prescribed medication. 14/03/2010 2 9 13 All medication must be administered as prescribed. If any errors occur appropriate medical advice sought, acted on and the details recorded. To ensure that people receive their medication as prescribed. 28/02/2010 3 11 15 Assessments and associated 30/04/2010 care plans must be reviewed on a regular basis and revised when peoples needs change. Care Homes for Older People Page 22 of 24 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that peoples needs are identified and met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Records pertaining to peoples weight should be easily accessible and enable staff to monitor individuals weight loss or gain and to take the appropriate action to ensure that peoples needs in relation to nutrition are being met. Records pertaining to peoples medication reviews should be easily accessible and enable staff to ensure that people are having their medication reviewed as required. Medication profiles should be kept up to date to show details of all of the medication that people are prescribed. A range of activities should be made available which reflects the interests, preferences and abilities of the people living in the home. 2 9 3 4 9 12 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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