Care Home: Willow Garth Care Home

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What the care home does well The home has developed a very good statement of purpose and service user guide.These give a good idea about what it would be like living in the home and what support and facilities someone could expect to receive. People are usually able to visit before making the decision to move in. People are able to take part in appropriate leisure and social activities and the food offered is of a good standard. The majority of daily routines and house rules promote independence and enable people living in the home to make decisions about everyday life. Three people living in the home have completed an NVQ 2 in catering, health and safety and food safety training, they currently help out in the kitchen. Peoples basic health needs are met and personal support is offered to people in a way that promotes their privacy and dignity. People feel their complaints are listened to. People live in a homely, comfortable and safe environment. Staff receive an induction programme over a three month period and this meets the common induction standards. People living in the home told us that their views are sought and acted upon. What has improved since the last inspection? A referral questionnaire has recently been developed that covers primary need, current medical conditions, current mental health, medication and risk including violent and challenging behaviour.The home then completes an assessment portfolio and the manager told us that this is usually completed following admission. People told us that they were able to make choices about other everyday life. The home has contacted all of the placing authorities and asked for the appointeeships to be returned to the local authority, mental capacity assessments have been undertaken with some people with regard to where they want to live and smoking restrictions. Patient passports have been developed and these give up to date information about the person, medication and relevant conditions if they are to be admitted into hospital. People live in a home where staff are now recruited in a safe way, staffing levels are sufficient to meet peoples needs. The manager told us that the staffing levels have been increased since the random inspection and currently 1020 care hours per week are in place. What the care home could do better: Peoples individual needs are assessed prior to admission. However, the home has taken unsuitable referrals for admission that does not fit in with its mental health registration category and that whose needs are too great for the home to meet. Staff do not always have the skills or knowledge to deal with the more diverse needs of people, such as learning disabilities, Parkinson`s disease, alcohol and substance misuse. This would ensure that people were only offered a place at the home if their needs were assessed fully and staff would have the necessary skills to deal with them. People have care plans that cover a range of identified needs and there are plans in place that describe difficult to manage behaviour. However, some plans do not specify the level of risk or give specific direction to the reader about what the risk is and how this is to be managed. The manager told us that charts have been introduced to record difficult to manage behaviours. However, these are not collated and the information gathered is not used to address any difficulties or patterns etc. The mealtime experience and how people receive their money is institutional and often when fracas and incidents occur. The medication procedure is not always adhered to and the recording is not always accurate. There is a safeguarding procedure and training is undertaken. However, not all staff have undertaken the safeguarding training and recent investigations by the local authority safeguarding team have proven that the home has offered a place to people whose needs they could not meet and putting other people at risk. Some essential training is not up to date and supervision is not offered as regular as it should be. The manager is not registered with CQC. Key inspection report Care homes for adults (18-65 years) Name: Address: Willow Garth Care Home Rolston Road Hornsea East Yorkshire HU18 1XP     The quality rating for this care home is:   one star adequate 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: Angela Tew     Date: 2 5 0 3 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 Adults (18-65 years) Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: Willow Garth Care Home Rolston Road Hornsea East Yorkshire HU18 1XP 01964534651 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): hatzfeldcareltd@btconnect.com Hatzfeld Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 58 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: either whose primary care needs on admission to the home are within the following category: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Willow Garth is located in a rural setting close to the town of Hornsea on the East Riding of Yorkshire coast. The home is now registered for 56 people of either gender who have mental health needs. Personal support is provided for people along with all meals and a laundry service. People have access to the homes minibus for outings and shopping, since access to local facilities in the nearby town is via the local bus service. Many people choose to walk to town along a road that is without pavement and Care Homes for Adults (18-65 years) Page 4 of 37 Over 65 0 58 Brief description of the care home lighting at certain places. The home has recently completed its programme of upgrading and it now has some new build properties within the grounds. Accommodation in the original house is in 19 single and 2-shared rooms, which are situated on two floors. There is no passenger lift available. The main house has a large conservatory lounge, a kitchen, two dining rooms, a meeting room, laundry and a medication room. There are 10 additional places provided in single storey ground floor rooms, equipped with en-suite toilet and shower, within converted outbuildings. Since the last inspection another 16 single rooms with en-suite toilet and shower have been created in a new build quadrangle also in the grounds. There is also conservatory within the quadrangle which just houses a snooker table for recreation. Willow Garth provides general information about the home in its Statement of Purpose and Service User Guide, both available on request from the provider. Care Homes for Adults (18-65 years) Page 5 of 37 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Following concerns received by CQC with regard to poor recruitment practices a random inspection was undertaken on 29.10.09 and the outcome was that a warning letter was sent to the provider outlining that the home was not recruiting staff safely and timescales were given for compliance to be achieved. During this inspection visit it was found that the recruitment of staff is being undertaken safely. Other areas of concern highlighted during the random inspection included taking people whose primary need was not mental health and where peoples needs had not been assessed thoroughly before a place was offered to them. A requirement was made that people must have their needs assessed and the home be sure that all of the identified needs can be met, before being offered a place to live. During this inspection Care Homes for Adults (18-65 years) Page 6 of 37 there remain concerns that the homes management continue to show a lack of understanding and awareness in relation to assessing peoples needs thoroughly and seeking information before a decision is reached to offer a place. The home has been without a registered manager since December 2007. This is evidenced over the previous two inspections. The management are failing to ensure that they are offering placements to people whose needs they can fully meet, meaning that peoples needs may not be met and they may not be protected from the risk of harm. This site visit took place over one day and took a total of 10 hours. Two regulation inspectors visited the home as part of the process. Prior to the visit surveys were posted out to people living in the home and staff members, information was gained from these and this has formed part of the evidence. The Annual Quality Assurance Assessment was returned to the CQC prior to the visit taking place. It had been completed to an acceptable standard. Several of the people living in the home were spoken to throughout the day about the care they receive and what it is like to live in the home, some of their comments have been included in this report. Four files of people living in the home and five staff personnel files were looked at during the site visit. Three staff members were spoken to, his was to find out what it was like working in the home and what training support and supervision was offered to them. A tour of the premises was undertaken and a number of records were looked at to ensure that the correct maintenance has been undertaken. The medication procedure and the way that incidents are reported was looked at and the manager was given feedback at the end of the visit. The manager told us that the current weekly fees charged range between £333.69 and £3,150.00. Additional charges are made for the following, newspapers, magazines and sweets, hairdressing. We also checked how privacy and dignity was maintained. We also wanted to be sure that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them. We would like to thank the people that live at Willowgarth, staff and management for their hospitality during the visit, and also thank the people who had discussions with us. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 37 Peoples individual needs are assessed prior to admission. However, the home has taken unsuitable referrals for admission that does not fit in with its mental health registration category and that whose needs are too great for the home to meet. Staff do not always have the skills or knowledge to deal with the more diverse needs of people, such as learning disabilities, Parkinsons disease, alcohol and substance misuse. This would ensure that people were only offered a place at the home if their needs were assessed fully and staff would have the necessary skills to deal with them. People have care plans that cover a range of identified needs and there are plans in place that describe difficult to manage behaviour. However, some plans do not specify the level of risk or give specific direction to the reader about what the risk is and how this is to be managed. The manager told us that charts have been introduced to record difficult to manage behaviours. However, these are not collated and the information gathered is not used to address any difficulties or patterns etc. The mealtime experience and how people receive their money is institutional and often when fracas and incidents occur. The medication procedure is not always adhered to and the recording is not always accurate. There is a safeguarding procedure and training is undertaken. However, not all staff have undertaken the safeguarding training and recent investigations by the local authority safeguarding team have proven that the home has offered a place to people whose needs they could not meet and putting other people at risk. Some essential training is not up to date and supervision is not offered as regular as it should be. The manager is not registered with CQC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 37 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs are assessed prior to admission. However, the home has taken unsuitable referrals for admission that does not fit in with its mental health registration category and that whose needs are too great for the home to meet. Staff do not always have the skills or knowledge to deal with the more diverse needs of people, such as learning disabilities, Parkinsons disease, alcohol and substance misuse. This would ensure that people are only offered a place at the home if their needs have been fully assessed and staff have the necessary skills to deal with them. Evidence: Following concerns received by CQC a random inspection was undertaken on 29.10.09, it was alleged that the home was taking people out of their registration category and whose needs they could not meet. We found that the home had offered places to people whose primary need was not mental health. One person was suffering from alcohol dependency and was using excessive amounts of alcohol on a daily basis. The persons mental health deteriorated resulting in incidents occurring that put the person and others in the home at risk. Eventually the person was admitted to hospital to undergo a detoxification program. The home did not undertake a thorough Care Homes for Adults (18-65 years) Page 11 of 37 Evidence: assessment or identify whether the persons needs were outside of their registration category. During this visit three care files were looked at and although these contained an assessment of need undertaken by the home, there were none from the placing local authority.The homes own assessment documentation has been improved since the random visit took place and includes a referral questionnaire that covers primary need, current medical conditions, current mental health, medication and risk including violent and challenging behaviour.The home then completes an assessment portfolio and the manager told us that this is usually completed following admission. However, we found that one person had been offered a place and moved in the home on 23rd February 2010 and the home had completed their own assessment for which contained basic information and a decision had been made to offer a place without receiving the local authoritys assessment or risk and relapse plan. The placement soon broke down resulting in the person being admitted into hospital following several incidents of self-harm, sexual and physical assaults taking place.The home received a copy of the risk and relapse plan on 1.3.10 which detailed several self-harming behaviours and significant risk or danger to others.East Riding Council safeguarding team also undertook an investigation with regard to allegations of a sexual nature and the outcome was that Willowgarth and the placing authority were both partially responsible for the lack of information sharing and lack of thorough assessment. The conclusion was that the home must ensure they do not accept referrals without documentation. The home must ensure that they receive sufficient information and carry out a thorough assessment of need and be sure that the persons needs can be met without putting other people living at Willowgarth at risk. The home has developed a very good statement of purpose and service user guide.These give a good idea about what it would be like living in the home and what support and facilities someone could expect to receive.They include photographs of the building, activities taking place and inform the reader of what is included in the fee and what is not.The statement of purpose states that people who have alcohol related difficulties will be expected to sign an agreement not to drink alcohol and the home has taken the decision to put in place a no alcohol policy.The service user guide has been amended and states when people will be liable for damages and that these will be assessed on an individual basis and in consultation with other agencies involved. We were told that the aim of the home is to offer rehabilitation and moving people back into independent living.The placement is open ended and the home works with other agencies such as health, social services and the private sector. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: People living in the home told us that they were able to visit before making the decision to move in.The manager told us, we encourage people to come and spend time with us before they move in. From speaking to staff and looking at personnel records it was clear that staff do not always have the skills or knowledge to deal with the more diverse needs of people, such as learning disabilities, Parkinsons disease, alcohol and substance misuse. The home offers a place to people with varied and sometimes complex needs. A staff member told us, I am key worker to someone with Parkinsons disease and I think training in this area would be good and would help me understand their needs better. Care Homes for Adults (18-65 years) Page 13 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans that cover a range of identified needs and there are plans in place that describe difficult to manage behaviour. However, some plans do not specify the level of risk or give specific direction to the reader about what the risk is and how this is to be managed. People are able to make some choices within the home. Evidence: We looked at a sample of files which belonged to people living in the home. We saw that a lot of work had been done by the manager in updating the plans of care and identified risks and some new forms had been introduced. We saw that each person had a care plan that covered personal care, health, communication, finances, social skills and current and past mental health issues. Some of the care plans included preferences for example, choice of female or male worker and times for getting up/going to bed. However, others did not and the content of the care plans varied greatly, some contained lots of information about a person and others were sparse. Some of the documents had not been signed or dated by the person living in the home. Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: The care plans are lengthy and difficult to follow, they do not read as though the person was fully involved in the development of them. Some are not clear about what intervention or approach is required by staff. Staff told us that they understood the basic needs of the people living in the home and could describe what some of the needs and risks were. However, staff also told us that the care plans and behaviour management plans did not always give clear information about what action was required by them or how they should deal with the person. Plans that describe risk and difficult to manage behaviour had been updated since the random inspection on 29.10.09 and these covered a variety of areas including; self harming, mental health issues, personality disorder. However, not all gave sufficient information to the reader in order for them to understand fully what the risk was and how this could be managed or reduced. For example, one plan stated behaviours during relapse were that the person may have flashbacks and nightmares, the triggers were not specific or detailed and it didnt tell the staff what to look for. There was too much information written onto one page and it was hard to follow or understand what the main areas of risk were or how staff should intervene. Another file looked at contained a risk assessment with regard to someone being moved off the floor, it stated that two staff were to lift the person. However, there was no thorough moving and handling assessment on file and the home does not have any lifting equipment. The manager told us that, no-one should be lifted and we would call for emergencies services to assist. The manager told us that charts have been introduced to record difficult to manage behaviours. However, these are not collated and the information gathered is not used to address any difficulties or patterns etc. Some of the files contained a risk and relapse plan that had been developed by the mental health service and these contained detailed information about the persons mental health history including associated risk and behaviours. People told us that they were able to make choices about other everyday events such as what time they would get up, when they would go out and whether they would take part in activities. People said, I make my own decisions, I choose what I wear and when I go out. There is a tea area in the dining room and people can make themselves drinks when they choose to. The home has put in place vending machines that give more choice to people with regard to snacks and drinks. During the random inspection on 29.10.09 it was found that some people had Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: restrictions put in place and decisions made for them without consultation with others involved. Since that visit the home has contacted all of the placing authorities and asked for the appointeeships to be returned to the local authority, mental capacity assessments have been undertaken with some people with regard to where they want to live and smoking restrictions. Paperwork was seen confirming that the home is working in partnership with other agencies and the person was fully informed of any restrictions in place. Overall the home promotes choice and self-determination allowing people to make decisions and take risks within their everyday life. People told us that they knew documentation was held about them and that they can have access to that if they wished to. We found that written documentation was sometimes judgemental about the person, for example, not just attention seeking. We received surveys from staff and overall they contained positive comments about the care provided, since joining in October 2009 I have been very impressed with the level of care all members of staff give to residents, Willowgarth try very hard to meet all the needs of each individual resident, gives a chance to gain life skills, I enjoy working here and interacting with the residents. Care Homes for Adults (18-65 years) Page 16 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in appropriate leisure and social activities and the food offered is of a good standard. However, the mealtime experience and how people receive their money is institutional and often when fracas and incidents occur. Evidence: The manager told us that the home is considered to be a care village offering support, care, advice, occupation and activity to those living there. There is an activities centre in the grounds and people can choose to take part if they wish to. The home offers a variety of activities including craft, games, table tennis, pool, there is a computer and some gym equipment for people to use. The manager told us that some new activities are now on offer to people that include a photography club, gardening club, dance exercise and choir practice. People told us that they enjoyed the new activities. The manager told us for those people with alcohol related problems such as Korsakoffs Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: syndrome, a structured activity programme is in place and that this forms part of their rehabilitation plan. People told us that they were able to use the activities centre and commented, I am getting involved, I like writing poetry, theres lots going on, we do photography, go out on trips, I like being pampered and getting my hair done, I like the trips out. People told us that they are encouraged to attend outside community groups and colleges and written evidence in case files confirmed this. The manager told us, we encourage people to attend college and take part in activities. Two of the care files looked at detailed when the people attend college or community groups. We received some staff surveys and these commented about how good the level of activities were in the home, the day care unit provides a wide range of activities for residents to keep active and motivated, trips out for residents. The majority of daily routines and house rules promote independence and enable people living in the home to make decisions about everyday life. It was observed that staff have developed good relationships with people and were respectful, polite and supportive throughout the day. People told us, the home is ok and I feel protected, the staff listen to me and I am getting more involved now, its the best place I have been to and they have helped me achieve my NVQ. However, the procedure for people accessing their personal monies does not promote independence or choice. We saw that people had to queue for their money in the office waiting room and this was for a considerable amount of time. It was very institutional and appeared to create a sense of anxiety and friction. Some people told us that this was very stressful and would like it to be changed. People should be able to take some control over when they receive their money and how, this would promote choice. The home continues to offer a varied menu and from speaking to people living in the home, it was clear that choice is offered and the quality of the food is good. People told us, the food is good here, the food is of a very good standard, I like the meals, the cooking is better, great food. However, people also told us that they had to queue for their meals and sometimes this was for long periods. Some comments included, we have to queue for our meals and sometimes this is for a long time, this is when people get upset and fights occur. The chef confirmed that people do have to wait in line and that this is sometimes for more than a few minutes. It appears to be a flash point for incidents occurring and the home should look at alternatives to people queuing up in an institutional fashion. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: The home has achieved the Heartbeat Award for healthily eating. The chef told us that the menu is displayed in the home and he also speaks to people to find out what they would like including on the menu. Three people living in the home have completed an NVQ 2 in catering, health and safety and food safety training, they currently help out in the kitchen and the chef said, we try to promote people getting involved and volunteering in the kitchen. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples basic health needs are met and personal support is offered to people in a way that promotes their privacy and dignity. The medication procedure is not always adhered to and the recording is not always accurate. Evidence: People using the service told us that they are supported to attend hospital appointments and for routines check ups such as hearing, optical and dental. People told us that the staff usually go with them if they need support. Written records were seen confirming that some people had seen the GP, the consultant Psychiatrist and community nurse and social workers. People also told us that the home promoted a healthy lifestyle and there was evidence where people are refusing to access health provisions that relevant people have been consulted and are aware and that the individual themselves is made aware of the risks of not having regular medical care. The manager told us that patient passports have been developed and these give up to date information about the person, medication and relevant conditions if they are to be admitted into hospital. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: The manager also told us that the infection control procedures have been updated and training has been arranged for all staff. One staff member has been given the responsibility for continence management. The home has a medication policy and procedure and currently uses Boots medi pack system, they receive delivery every four weeks and medication is supplied in separate containers. The medication is recorded onto the medication administration record (MAR) and ongoing stock control sheets and if any medication is left over or not required it is returned at the end of the month. However, during the inspection one persons medication was found to have been signed for as administered, but the medication remained in the medi pack. This is a gap in the procedure with the potential for medication being taken and no ongoing record of what was left in the medi pack on a weekly basis. A major discrepancy was found during the inspection visit, one weeks supply of Quetipine was missing. On 24.3.10 the person had been on social leave and the medication was recorded as not given and the total remaining should have been 13, however, there was only enough medication to last that week. The home informed the Police and made a safeguarding referral to East Riding Council and the staff undertook a thorough search of the premises. However, the medication was not found and the safeguarding investigation is ongoing. The home has a secure medication room, containing locked controlled drugs cabinet and a refrigerator. The controlled drugs register matched with the medication stock held. The home has introduced a new procedure whereby two staff members administer medication, once administers and one checks it is correct. Care Homes for Adults (18-65 years) Page 21 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel their complaints are listened to, however the records are not always signed and dated. There is a safeguarding procedure and training is undertaken. However, not all staff have undertaken the safeguarding training and recent investigations by the local authority safeguarding team have proven that the home has offered a place to people whose needs they could not meet and putting other people at risk. Evidence: The home has a complaints procedure and it was confirmed from speaking to people living in the home and staff that complaints are listened to and acted upon. There have been seventeen complaints since the previous inspection visit. The manager told us that the complaint is discussed with the person making it and they are given feedback with regard to the outcome. However, some of the documentation looked at was not signed or dated. People are informed about how to complain in the service user guide and the surveys we received stated this too. People told us that they would speak to one of the staff or the manager if they had a complaint. The home has a multi agency policy and procedure for the prevention of abuse. The manager told us that all staff undertake mandatory training in this area, however from looking at records it was clear that some staff had not undertaken this essential training. The manager said, we are awaiting further dates for staff to attend the training. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: During the random inspection on 29.10.09 it was found that staff were on occasion having to physically restrain people, however, they had not received any form of physical intervention training. A requirement was made that all staff must undertake the training by 29th January 2010, during this inspection the manager gave an update and confirmed that one of the directors had undertaken a four day course registered with the British Institute for Learning Disabilities (BILD) that covered the use of physical intervention and this training has been cascaded to the care staff and will be completed by the end of March 2010. The manager told us that there have been no further incidents that required the use of physical intervention by staff. During the random inspection on 29.10.09 it was found that the home had not been making safeguarding referrals when assaults took place between two people living in the home. The manager told us that she was unaware that she had to report these as safeguarding incidents. Since then the home has made 18 safeguarding referrals to the Local Authority Safeguarding team and there are three outstanding referrals that relate to people living in the home who have alleged they have been subject to sexual assaults. These are currently being looked into by the local authority, these will be commented upon in the next inspection report. People living in the home told us that usually they feel safe in the home and some comments included, yes I feel safe, usually I feel protected, I dont like it when people shout at each other and sometimes have fights. The manager told us that the majority of staff have undertaken Mental Capacity Act and Deprivation of Liberty training. The manager has also attended the safeguarding for managers, Mental Capacity Act and Deprivation of Liberty training. From looking at written records it was clear that the home is recording and reporting incidents to the appropriate agencies. From speaking to the staff it was evident that they had a basic understanding of safeguarding people from harm and they could describe the various forms of abuse and stated that they would pass any concerns onto the manager or senior. Records were examined about difficult to manage behaviour or incidents that had occurred including verbal or physical violence displayed by the people living in the home. Some records were brief and did not give clear direction to staff about how they should intervene. Behaviour charts, risk management and daily records must be clear and specific about incidents to ensure that people are protected from abuse. As this was commented upon earlier in the report no further requirement will be made in this section. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: The home has policies for dealing with peoples finances and during the random inspection on 29.10.09 it was identified that the home was acting as appointee for twenty six people and it was recommended that where possible this should be someone independent of Willowgarth. During this inspection the manager told us that the majority of people have the placing local authority acting as their appointee and not the home. Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, comfortable and safe environment. Evidence: During the visit a tour of the building was undertaken and overall the standard of accommodation is good. The communal areas were homely, clean and comfortable. Surveys received from people commented, Im perfectly happy here, my room is always kept fresh and clean, good living quarters. People living in the home had personalised their room with belongings, TV, music systems, pictures and posters. The home has been subject to development and has recently increased its numbers and can take up to 56 people who have mental health needs. The newly finished accommodation is of a very good standard, each unit has its own bedroom, wet room and lockable front door. There is a new laundry room which is well equipped. People are enabled to undertake their own washing and ironing with the guidance and help from staff. The manager told us that the home has had a new fire alarm and heating system have Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: been installed. Care Homes for Adults (18-65 years) Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where staff are recruited in a safe way, staffing levels are sufficient to meet peoples needs. However, some essential training is not up to date and supervision is not offered as regular as it should be. Evidence: The manager told us the home employs 24 care staff and 14 of those have obtained NVQ level 2 in care. Three staff members were spoken to and although they could describe the basic needs of people living in the home, some were not so clear about specific need such as mental health, learning disabilities, substance misuse, Parkinsons. The home currently does not offer basic training in any of the afore mentioned. During the visit staff were observed to be patient, calm and supportive when dealing with people. It would appear that they have developed very good relationships and the atmosphere was relaxed. It was noted that staff respect the person and their privacy at all times and also supported people with everyday chores. Staff spoke to people living in the home in a way that was encouraging and enabling to the person. People living in the home told us, the home caters for individual needs, staff are usually very good, I myself dont need much help, but the ones who need it most are cared for very much, sometimes staff listen. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: People living in the home told us that there are enough staff on duty to support them in going out or undertaking activities. Some people said, staff are supportive, they are very good and are nice to me. We received surveys from people living in the home and overall the comments were positive about the care and support offered. However, two people did state, staff to be more polite including the manager, the management should have more time to speak with you and be more helpful. The manager told us that the staffing levels have been increased since the random inspection and currently 1020 care hours per week are in place. She said, we have increased the actual care hours and there are more staff on duty on each shift. Staff told us, yes usually there are enough staff, generally there enough staff on duty, at times there are not enough, but it has improved. The home has increased its staffing levels and this meets the minimum amount recommended. During the random inspection on 29.10.09 it was found that the home was recruiting staff unsafely and without appropriate checks. During this inspection it was clear that the home has addressed these issues and new staff are not being employed or commencing duties before appropriate checks are in place. We saw evidence that a criminal records bureau (CRB) and appropriate checks were in place before the person works in the home. Records looked at confirm that staff receive an induction programme over a three month period and this meets the common induction standards. Five staff files were looked at and a training matrix and although this showed that the majority of essential training is up to date, some were not and these included safeguarding adults, fire safety, infection control and mental capacity act. The manager told us that staff meetings and supervision are occurring on a regular basis. Staff members told us that they received both informal and formal support and comments included, I do received supervision and if there are any problems theres always someone to ask, supervision is offered regularly, its monthly and recorded, but support is available at all times. Written records showed us that although supervision is offered to staff, it is not as regular as it should be. One staff member had not received formal supervision since October 2009. Care Homes for Adults (18-65 years) Page 28 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that seeks peoples views about the service they receive and their individual needs are assessed prior to admission. However, the home has taken unsuitable referrals without understanding their needs and any associated risks. Staff are trained and receive support, however, if training in diverse needs were offered, this would ensure staff have the skills and knowledge required to maintain the health and safety of those living in the home. People live in an environment that is relatively safe environment. Evidence: As mentioned earlier in the report we found that one person had been admitted to the home on 23rd February 2010 and the home had completed their own assessment for which contained basic information and a decision had been made to offer a place without receiving the local authoritys assessment or risk and relapse plan. The placement soon broke down resulting in the person being admitted into hospital following several incidents of self-harm, sexual and physical assaults taking place.The home received a copy of the risk and relapse plan on 1.3.10 which detailed several self-harming behaviours and significant risk or danger to others.East Riding Council Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: safeguarding team also undertook an investigation with regard to allegations of a sexual nature and the outcome was that Willowgarth and the placing authority were both partially responsible for the lack of information sharing and lack of thorough assessment. The conclusion was that the home must ensure they do not accept referrals without documentation. The home must ensure that they receive sufficient information and carry out a thorough assessment of need and be sure that the persons needs can be met without putting other people living at Willowgarth at risk. CQC has formally warned the home that they are committing an offence and that if they do not make the required changes within a defined period, prosecution might ensue. Over the past two years the home has increased its capacity to 56 beds and it has been offering places to people with very complex needs including dual diagnosis, personality disorder, substance misuse, which in turn has posed further difficulties for staff managing such conditions and associated behaviours. There has been a clear lack of understanding in relation to mental health issues and processes both within the home and with regard to other agencies. The manager had been unaware until the random inspection in October 2009 about when to refer to the safeguarding team and other processes within the mental health services such as mental capacity assessments and when a person has their liberty restricted or deprived. She has since undertaken training with regard to safeguarding adults, mental capacity and deprivation of liberty. The current manager is not registered with CQC and the home has been without a registered manager since December 2007. Following the inspection visit CQC were informed by one of the directors of the company that the current manager would step down and revert back to her role as deputy manager. One of the the directors will takeover managing the home on a full time basis until a suitable manager is recruited. We did not look in depth at the way the home quality assures its service. However, people living in the home told us that their views are sought and acted upon. Service user and staff meetings are held regularly. Surveys are given to people living in the home, relatives and other professionals and the results are gathered and a report is prepared giving the outcome. Visits required by CQC under regulation 26 are undertaken by the company and reports are held in the home. Staff had not received sufficient training in how to meet the specific needs of people including learning disability, mental health, personality disorder, Parkinsons disease Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: and substance misuse. Therefore staff do not always have the skills or knowledge to deal with the more diverse needs and people may be put at risk. Care Homes for Adults (18-65 years) Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 2 14 People must have their 29/01/2010 needs assessed and the home be sure that all of the identified needs can be met, before being offered a place to live. This would ensure that the home can meet all of the assessed needs of the people living there. This requirement was made at the random inspection on 29/10/2009 and the timescale has been extended to enable the home to make the improvements required. Care Homes for Adults (18-65 years) Page 32 of 37 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 3 18 Staff must undertake specialist training including learning disability, mental health, alcohol and substance misuse, Parkinsons disease. This would ensure that they have the knowledge and skills to deal with peoples needs. 25/09/2010 2 6 15 The care plans require 25/09/2010 further development to include specific direction to staff about what they need to do and any preferences to the person receive their support. This would ensure that care plans are developed in a way that includes the persons choices and preferences and would give clear direction to staff. Care Homes for Adults (18-65 years) Page 33 of 37 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 3 6 15 Care plans must be developed with the person and be written in a way that is easy to understand. This would ensure that the person reading the plan is clear about what the needs are and the support required. 25/09/2010 4 9 12 Where people present 25/09/2010 behaviours that are either harmful to themselves or others, there must be a plan giving clear guidance to staff about how to manage these. This would ensure that staff are clear about what they need to do in order to manage or reduce the risk/behaviour. 5 9 13 The home must provide a safe system for moving and handling people, with appropriate risk assessment documentation, equipment and training for staff. To ensure that people receive assistance from staff that are trained using the appropriate equipment. 25/09/2010 6 20 13 Medication must be administered as prescribed, accurate records must be kept for all medicines. 25/04/2010 Care Homes for Adults (18-65 years) Page 34 of 37 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 This will make sure that people receive their medication correctly and the treatment of their medical condition is not affected. 7 23 18 All staff must undertake the 25/06/2010 safeguarding adults training. To ensure that staff understand and can identify abuse, also to ensure people are safe and protected. 8 35 18 Essential training must be undertaken and updated when required, including safeguarding adults, fire safety, mental capacity and infection control. To ensure that staff receive appropriate training in maintaining the health and safety of people. 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 25/08/2010 1 6 All documentation relating to the identification and meeting of peoples needs should be signed and dated, to ensure that it is clear when documents are reviewed and updated and by whom. Behaviour charts should be monitored and used to assist the reduction of any difficult to manage behaviours. The home should review the way in which people receive Page 35 of 37 2 3 6 16 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations their personal allowance. This would ensure that people have choice and their dignity maintained. 4 17 The home should review the way in which meals are served and look at alternatives to people standing in line and waiting for long periods. This would ensure that people have choice and have their dignity maintained. Medication should audited on a regular basis, then any discrepancies can be identified and rectified. Complaints should be signed when completed. To ensure that records are clear and up to date and indicate that the complaint has been dealt with. Supervision should be undertaken with staff a minimum of six times per year. This would ensure that staff receive appropriate and ongoing support. The manager should be registered with CQC and hold the relevant NVQ qualifications, to ensure that a qualified and approved person is running the home. 5 6 20 22 7 36 8 37 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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