Care Home: Willow House

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What the care home does well The needs of the people being admitted to the home are assessed prior to admission ensuring the home can meet their needs. Each person has a care plan so that staff know how to support them to meet their needs. The home tries to provide an enabling environment for people, they are encouraged to try new activities and learn new skills. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. A choice of food is offered to people and they have a healthy diet to help them keep well. The people living in the home receive attention from health care professionals as needed to help with meeting their health care needs. The staff were seen to have good relationships with the people living there and spoke to them naturally, with empathy and supporting them as they wish. This gives people a sense of wellbeing. Staff have the training they need so they know how to support the people living there. The home has in place a quality monitoring system based on seeking the views of the people living there so they decide how improvements are made. What has improved since the last inspection? People have been provided with a copy of their terms and conditions with the home so they know what some of their rights are. The dining room floor has been repaired so that it looks nicer and is not a trip hazard. A new bath is due to be installed that will be easier for people with mobility difficulties to get in and out of. Staff are recruited and selected in ways that ensure safe skilled individuals are employed. Staff have been given more training and provided with more information so they know what to do to safeguard people from abuse. The way in which fire drills are recorded has been improved so that it is easier to track that all staff have participated in a drill and so know what to do to keep people safe should a fire occur. The manager has been registered with us to make sure they have the right experience, knowledge and qualifications to manage the home for the benefit of the people living there.Willow HouseDS0000068615.V374977.R01.S.docVersion 5.2 What the care home could do better: The service users guide needs further development so that people know how much it costs to live there. Consult further with people at the home regarding leisure arrangements for weekends to help ensure they meet people`s wishes and expectations. Written protocols should be improved for individuals who are prescribed medication on an `as required` basis to ensure staff have clear guidance as to when they should or should not be given. Staff should not work excessive hours so they are not at an increased risk of stress and people who live at the home are supported by staff who are at their best and not tired. Key inspection report CARE HOME ADULTS 18-65 Willow House 229 Portland Road Edgbaston Birmingham B17 8LS Lead Inspector Kerry Coulter Key Unannounced Inspection 7th & 8th April 2009 09:10 Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow House Address 229 Portland Road Edgbaston Birmingham B17 8LS 0121 420 0210 0121 429 4744 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Castlebeck Care (Teesdale) Limited Louise Claire Smith Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may admit up to 8 service users with a learning disability who may also display varying degrees of challenging behaviour, a mental disorder, physical disability or sensory impairment. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- Learning Disability (LD 8) and Learning Disability over the age of 65 (LD(e) 8). The maximum number of service users to be accommodated is 8. 3. Date of last inspection 21st April 2008 Brief Description of the Service: Willow House is registered for eight adults who have learning disabilities who may also have additional needs such as mental health or behaviours that may challenging the service. The home is a detached house located on Portland road, Edgbaston. There are shops and services within walking distance to include supermarkets, hairdressers, restaurants, library and Churches. The home is close to local bus routes. The accommodation is located over two floors, a lift is available to the first floor for anyone who has mobility difficulties. The home offers single bedroom accommodation with en-suite facilities. There is a large dining room, lounge and second smaller lounge. The home has a large kitchen and a second training kitchen for use by people who live at the home. The service users guide did not state the fees charged to live at the home. A copy of the last inspection report is available in the home for visitors to read if they wish to. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over two days; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2009 to 2010. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA) completed by the manager. This provides information about the home and how they think it meets the needs of the people living there. We also sent surveys to seven people who live at the home, four were returned to us. Six surveys were sent to health professionals and two were returned. Nine surveys were sent to staff and eight were returned. Two of the people living in the home were case tracked. This involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. We looked at parts of the home. A sample of care, staff and health and safety records were looked at. The people living there were spoken to and asked their views on living in the home. The manager and staff on duty at the time were spoken with. What the service does well: The needs of the people being admitted to the home are assessed prior to admission ensuring the home can meet their needs. Each person has a care plan so that staff know how to support them to meet their needs. The home tries to provide an enabling environment for people, they are encouraged to try new activities and learn new skills. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 6 People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. A choice of food is offered to people and they have a healthy diet to help them keep well. The people living in the home receive attention from health care professionals as needed to help with meeting their health care needs. The staff were seen to have good relationships with the people living there and spoke to them naturally, with empathy and supporting them as they wish. This gives people a sense of wellbeing. Staff have the training they need so they know how to support the people living there. The home has in place a quality monitoring system based on seeking the views of the people living there so they decide how improvements are made. What has improved since the last inspection? People have been provided with a copy of their terms and conditions with the home so they know what some of their rights are. The dining room floor has been repaired so that it looks nicer and is not a trip hazard. A new bath is due to be installed that will be easier for people with mobility difficulties to get in and out of. Staff are recruited and selected in ways that ensure safe skilled individuals are employed. Staff have been given more training and provided with more information so they know what to do to safeguard people from abuse. The way in which fire drills are recorded has been improved so that it is easier to track that all staff have participated in a drill and so know what to do to keep people safe should a fire occur. The manager has been registered with us to make sure they have the right experience, knowledge and qualifications to manage the home for the benefit of the people living there. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have most of the information they need to make a choice of whether or not they want to live there. Before people move into the home their needs are assessed so it is clear they can be met at the home. EVIDENCE: The service user guide has been up-dated since our last visit to the home to include details of the new manager for the home. Further improvement is still needed to the guide so that people have information about the range of fees charged. The guide is in an easy read format that includes some photographs of the home. The manager said that it was intended to further improve the guide and that consideration would be given to producing an audio version. People who live at the home told us that they had received enough information about the home before they moved there. One person told us ‘the manager and the deputy came to see me and gave me lots of information, I came and stayed to see if he liked it. I chose the colours of my bedroom and they arranged for it to be painted before I moved in’. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 10 We looked at the admission procedure followed for one person who had been admitted since our last inspection. Before they moved in an assessment of their needs was completed to ensure their needs could be met at the home. It is good that before people move in they are consulted about what their expectations of the home are, views of their social worker and involved health professionals are also obtained to ensure people’s expectations are realistic. It was identified at the last inspection that people who live at the home did not have a copy of a contract or statement of terms and conditions. These have now been made available to people who live in the home so they are aware of the terms and conditions of their stay at the home. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have detailed information in care plans as to how support each person so that their individual needs are met. People who live in the home are supported to make decisions about their lives to enhance their independence. EVIDENCE: We looked at the care provided to two people at the home. Each person had an individual care plan. These detailed how staff are to support the individual to meet their needs and achieve their goals. Care plans had been regularly reviewed to ensure that the care plan was still effective in meeting the individual’s needs. People are involved in contributing to their plans and offered the opportunity to sign the care plan agreement. Regular review meetings are held about the care provided and people can attend these meetings if they choose to. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 12 Since we last visited the home staff have helped people complete ‘My Plan’ documents. These contain information about the persons likes and dislikes and wishes for the future. ‘Capacity to consent’ assessments are completed for all people who live at the home to assess their ability to make informed choices and decisions about their lives. These are regularly reviewed. Staff were observed throughout the visit giving people choices about what they wanted to do, eat, drink or where they wanted to spend their time. One person told us ‘I choose when I go to bed and get up in the morning’. Records showed that regular meetings are held with the people living there. Minutes of these showed that people talked about topics such as activities, holidays, the menu and household chores. At the meetings people make some decisions about the running of the home. For example recently people had a vote about washing their own crockery after lunch. Records included individual risk assessments. These detailed how staff are to support individuals ensuring that they are safe and the risks to their health and welfare are minimised. As with care plans these had been reviewed as often as necessary to ensure they are still effective in ensuring the safety and well being of individuals. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place so that people living in the home experience a meaningful lifestyle. People are offered a healthy diet that they enjoy and that meets their dietary needs. EVIDENCE: Discussion with staff indicates the home tries to provide an enabling environment for people, they are encouraged to try new activities and learn new skills. Staff work with people who live in the home to agree a set of targets to work towards to help them achieve more independence. People are supported to learn skills such as cooking in the home’s training kitchen, numeracy and literacy. Healthy lifestyle sessions have been introduced where people have learnt about things such as healthy eating and self care skills. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 14 Each person has their own timetable of activities. For some people their timetable is in a pictorial format so that it is easier for them to understand. Whilst there are some group activities most activities on offer are on an individual basis. Records sampled and discussion with staff show activities on offer are wide ranging and include shopping, pub, walks, library, college, swimming, concert visits and computing. One person’s care plan recorded that their goals had included joining a gym and doing a painting and decorating course at college. We saw evidence that staff had acted on these goals and the person had been supported to join a gym. Staff have also been making enquiries about suitable college courses. The home has recently got an allotment, people have put designs on display in the home for what they want to grow there. People told us they had been to Dudley Zoo the previous day and had really enjoyed it. They also told us they were going to the seaside the following day. One person told us it had been their birthday recently and they had chosen to go out for a meal to celebrate. They also told us ‘I’m happy here’. Discussions with people show that they have the opportunity to have an annual holiday. One person told us ‘I have been on holiday to Jamaica last year, and have chosen to go to Scotland this year’. People we spoke with were all happy with the activities on offer during the week but for some people the leisure activities on offer at the weekends do not appear to meet their expectations. People told us ‘sometimes I get a little bored at weekends’ and ‘there are lots of activities, we sometimes go out at weekends if there is enough staff’. Records show that staff support contact with family by telephone, visits and letters. People are also supported to maintain contact with friends. Where restrictions are placed on people who live in the home this is recorded in their care plan and where possible people have signed their agreement. Restrictions in place were seen to be for the safety of individuals, for example one person had temporarily had their room keys taken away from them. Records and discussions showed this was because they had used the keys for self harm. Minutes of meetings with other professionals shows they had agreed to this action in the persons best interests. It is a house rule that people are not allowed to have alcohol in the home unless agreed by the manager, however this is clearly recorded in the service user guide so that people know about this before they move to the home. One person told us ‘there are no unfair restrictions here’. Food records are completed daily for each individual, these show a varied diet with lots of fruit and vegetables. The home’s menu was on display in the dining room, this showed that people are offered choices and given the Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 15 opportunity to try foods from different cultures. Food is very varied, the evening meal choices one day of our visit was either scampi or sirloin steak. Lunch time practice was observed during the visit. Staff ate with people who lived at the home making lunch a social occasion. Choice of meal was available and fresh fruit or yogurt was available for dessert. All meals are freshly prepared by the chef, for example homemade soup and homemade beef burgers. Since our last visit the home has had a visit from the Environmental Health Officer who has rated the food hygiene arrangements as excellent. People who live at the home told us ‘food here is fantastic, very good’ and ‘the food is okay, I don’t not like the curries but can choose something else’. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home receive personal support in the way they prefer and require and their health needs are well met. Medication practice needs minor improvement to ensure people receive the medication they need safely. EVIDENCE: People who live at the home were observed to be well groomed and dressed according to age, gender and culture. Daily records show people are supported to go out with staff to buy their personal toiletries and new clothes. People’s care plans had information regarding personal care so that staff know if people need any support. Full health assessments are completed for each new person at the home. Records showed that people are referred to health professionals where appropriate. They also have regular health check ups, for example with the dentist and optician. Records of all appointments were kept including the Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 17 outcome with any action that staff need to take to ensure the individuals health needs are met. As stated earlier in this report staff are working with people on eating healthily. Weight monitoring of people living at the home is undertaken to ensure they are a healthy weight. Since our last visit to the home one person has been diagnosed as having diabetes. There was clear information in their care plan so that staff would know the signs of them being unwell and what to do about it. We spoke with two staff who were aware of the care the person needed to stay healthy. Records show that the person has been supported to attend diabetic education sessions at the health centre. Training has been scheduled regarding diabetes for three staff and the manager said it is intended to arrange further training for other staff. Surveys we received from health professionals indicate they feel the home meets people’s health needs. One professional commented ‘team co-ordinates with other professionals where needed’. The home offers nursing care and all medication is administered by a qualified nurse. Staff said that none of the people living there were self medicating at present. We have not been informed of any medication errors occurring since the home’s last inspection. For the people we case tracked records showed they had regular medication reviews to make sure they were having the medication they needed. Medication is stored in a secure cabinet that was clean and well organised. At the time of our visit the thermometer in the cabinet showed that its temperature was 26.6°C. This is a little too warm as some medication stored in the cabinet should have been stored below 25°C, in line with the manufacturers instructions. The medication administration chart (MAR) were sampled for three people. These were seen to have generally been satisfactorily completed and indicated people had been given their medication as prescribed. Staff ensure they take a photocopy of the prescription so that they can ensure people are given their medication as prescribed by their GP. A record of what homely remedies each person can take with their prescribed medication is kept. This ensures that people can take cough and cold remedies for example whilst knowing that these will not have a detrimental effect to their health because of the prescribed medication they take. Some people at the home are prescribed medication on an ‘as required’ basis. At our last visit we made a recommendation to improve the information that guides staff when to give this medication. At this visit we found that for some Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 18 ‘as required’ medication there was clear guidance on its use, kept with the medication record for ease of access. For some other medications, for examples those used for behaviour the information should be further improved. For example for one person information recorded that they would ask for their medication when they needed it, there was little guidance at what stage it should be offered by staff. It would also be beneficial to keep this information with the person’s medication record for ease of access by staff. When giving ‘as required’ medication staff would then be able to quickly establish that they are following the guidelines. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on and they are protected from abuse so ensuring their well being. EVIDENCE: The home has a complaints procedure that is on display in the hallway. It is in an easy read format that includes pictures making it easier for people to understand. One person at the home has a visual impairment and would not be able to read the procedure. They told us ‘staff have told me how to complain’, they also said ‘I am not that fussed’ when asked if they would like an audio version of the complaints procedure. All people we spoke with and received surveys from said they were aware of the complaints procedure. People told us ‘aware of the complaints procedure and staff listen’ and ‘if any problems can speak with staff, they listen to you, can complain if you want to’. The home told they had received five complaints in the last twelve months. We looked at their log of complaints and this showed that most of these had been made by people at the home about the behaviour of other people who live there, two complaints were made about members of staff. We looked at the records of the complaint investigations. We found that the record keeping for complaints had improved since our last visit. Records sampled showed that the complaints had been taken seriously and appeared to have been fully investigated. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 20 We have not received any complaints about this home but have received one anonymous concern. The concerns covered various issues including staff not knocking on doors, restrictions placed on people and lack of advocates. We looked at these issues during our visit and found that the home was not breaking any regulations. We spoke with three people at the home who all confirmed that staff always knock on their doors before entering their room. Records show some incidents when physical intervention has been used when individuals have attempted to harm themselves or physically attack staff. The use of physical intervention is agreed in people’s care plan in consultation with involved care professionals. Records and discussion with staff show low arousal techniques are tried before physical intervention is used as a last resort. Staff at the home have completed physical intervention training and a rolling programme of refresher training is in place. Staff training records and discussion with the manager and staff shows that most of the staff have had training on protecting people from abuse. Records show that for the minority of staff who still need this training it has been booked. The home has a policy on protecting people from abuse and as recommended from our last inspection have a copy of the Birmingham Multi Agency Guidelines, so that staff have the information they need. We spoke with two staff about what they would do if an allegation of abuse was made about a member of staff. Both were able to describe action that would safeguard people. In the last twelve months there have been two safeguarding incidents in the home. One allegation was about another person at the home, the other was about a member of staff. Both were notified to social services and investigations undertaken to ensure people were safe. Investigations did not uphold the allegations made. Procedures are in place to safeguard people’s money. The home has two separate safes, the bulk of money is stored in a safe that has restricted access. Checks on monies held are completed daily and weekly. Finance records for one person were sampled. No inappropriate spending was evident on things that the provider should purchase and receipts for expenditure were available. During our visit a financial audit of people’s money was being completed by a member of finance staff from the provider’s headquarters. They told us that audits are completed six monthly and that the outcome of this audit was good. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally live in a homely, safe and clean environment that meets their individual needs. EVIDENCE: The accommodation is located over two floors, a lift is available to the first floor for anyone who has mobility difficulties. The home offers single bedroom accommodation with en-suite facilities. There is a large dining room, lounge and second smaller lounge. The home has a large kitchen and a second training kitchen for use by people who live at the home. The annual assessment (AQAA) completed by the manager indicates that in the coming year a new conservatory is to be built. Redecoration of communal areas and some bedrooms is also planned. During our visit one person went out with staff to choose the new paint for their bedroom. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 22 At the last inspection we noticed that the floor covering in the dining room needed attention where it has lifted from the floor lifted resulting in small ridges. This has now been repaired so that it looks nicer and is not a trip hazard. Three people who live at the home gave permission for their bedrooms to be seen. Bedrooms seen reflected individual tastes and interests and contained individual’s person possessions that reflected their age, gender and cultural background. All three people spoken with said they were happy with their bedrooms. The annual quality assurance assessment recorded that it was planned to have a new bath fitted in the communal bathroom. At this visit one of the people living there showed us a new picture of the bath they were having, they seemed very pleased about it. The manager told us that installation of the new bath was planned the following week. The new bath is of a type that is easier for people with mobility difficulties to get in and out of. Infection control procedures are satisfactory. The home was clean with no unpleasant odours at the time of the visit. Satisfactory hand washing facilities were observed in bathrooms, toilets and kitchens. As already stated earlier in this report the home has been awarded an excellent food hygiene rating by the Environmental Health Officer. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development generally ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. EVIDENCE: Staff were observed communicating with people who live in the home in a manner they understood that was polite and respectful. Care staff have the opportunity to complete the Learning Disability Award and then go on to completing a National Vocational Qualification (NVQ) in care. Staff surveys received indicate they generally felt the staffing levels in the home met peoples needs. Current staffing levels are usually one nurse and three support workers during the day and one nurse and one support worker at night. Care staff are supported by a chef, administrative, maintenance and domestic staff. The home does not use agency staff to cover any staffing shortfalls but uses their own bank staff to make sure that people are supported Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 24 by staff they know. As identified at the last inspection, sometimes staff work long hours. For example two fourteen hour shifts in a row. This could result in staff not performing at their best and being more prone to making mistakes through being tired. We looked at the recruitment records of two staff. These included the required recruitment records including evidence that a satisfactory Criminal Records Bureau (CRB) check had been completed to ensure that suitable people are employed. We also looked at the recruitment records for another staff who had been recruited but not yet started working in the home. This showed that all the necessary recruitment checks had been completed and that the home was awaiting the CRB check before the person started. Recruitment practice helps to ensure that the people living there are protected from having unsuitable staff working with them. All but one of the staff surveys received was positive about the induction they received. Staff spoken with during our visit said they received the training they need. Training records and discussions with staff show that staff receive training in physical intervention, fire, first aid, epilepsy, manual handling, challenging behaviour, health and safety and the mental capacity act. Some staff have recently had training about mental health law, communication and deprivation of liberty. This ensures that they know how to meet the needs of the people living there. Staff spoken with said they got good support from the manager. There are systems for supervision and annual appraisals so that staff are supported in their role and their training and development needs can be identified. Regular staff meetings are also held so that staff are kept informed and updated with information that is important in meeting the needs of the people living there. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements ensure that the home is safe and usually well run in the way that the people living there want. EVIDENCE: Since our last inspection of the home the manager has been registered with us. The manager is a qualified nurse and has undertaken a management course. The training records for the manager show she has kept herself up to date and attended regular training. The manager completed the annual quality assurance assessment to a good standard and returned it when we asked for it. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 26 Where we made requirements at our last inspection the manager has ensured these have been acted on and improvements made. The manager has generally ensured that we have been sent notifications as required about incidents in the home. Unfortunately we were not sent a notification regarding an allegation made about staff, however the manager has assured us that she will ensure all required notifications are sent to us. Discussions with staff at the home indicate that the manager is approachable and listens to what people have to say. Comments from staff included ‘manager is firm but fair, she’s great, can approach her with anything’. The home is still relatively a new service but Castlebeck are an established provider and have over time developed good quality assurance systems. The area manager visits the home, usually monthly and produces a report of his visit. These audits included seeking the views of the people living there and staff. Internally, quality audits are completed monthly and sample areas such as medication, environment, complaints, record keeping, activities and care planning. When an area for improvement is identified an action plan is completed. Since our last visit the home has also achieved ISO 9001 certification (quality management systems) this was audited and awarded by an external company. Castlebeck have their own satisfaction forms that people living at the home can complete. These have been completed recently by people and the results are on display in the home in graph form. The system would be enhanced if the home put information on display for people about what they were doing to improve things where some people had identified they felt things neeeded to improve. Good systems are in place to monitor accidents. Monthly reports are sent to headquarters and identify any reoccurring trends in the accidents that have occurred. Risk assessments were in place for the building, people smoking and the equipment used in the home. This ensures that action can be taken to minimise the risks to peoples safety and well being. Records sampled showed that equipment in the home is regularly serviced and well maintained so it is safe to use. Records showed and the AQAA stated that a qualified person had tested the gas and electrical appliances to ensure that they are safe to use. Staff test the water temperatures weekly to make sure that the water is not too hot or cold and people are not at risk of being scalded. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 27 Fire records showed that staff test the fire equipment regularly to make sure it is working. There are regular fire drills so that staff and the people living there would know what to do if there was a fire so minimising the risks to their safety. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 4 13 3 14 2 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 3 X Version 5.2 Page 29 Willow House DS0000068615.V374977.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The service users guide should be updated to include details of the new manager and state what the fees charged to live at the home are. This will give prospective service users all the information they need so they can make a choice as to whether or not they want to live there. Consult further with people at the home regarding leisure arrangements for weekends to help ensure they meet people’s wishes and expectations. Written protocols should be improved for individuals who are prescribed medication on an ‘as required’ basis to ensure staff have clear guidance as to when they should or should not be given. Review the arrangements for the storage of medication to ensure it is stored at a temperature in line with the manufacturers instructions. Staff should not work excessive hours so they are not at an increased risk of stress and people who live at the DS0000068615.V374977.R01.S.doc Version 5.2 Page 30 2. 3. YA14 YA20 4. 5. YA20 YA33 Willow House home are supported by staff who are at their best and not tired. Willow House DS0000068615.V374977.R01.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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