Care Home: Willow House

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What the care home does well Our survey and the home`s own survey showed very high levels of satisfaction with the home. The AQAA showed that staff and people living in the home were routinely consulted about how things were done, and what changes they might like to try. All parts of the home appeared well maintained and clean to a good standard. There was an annual plan for regular spring cleaning of bedrooms and shared rooms. Monitoring records showed this was adhered to. An environmental health inspection of the kitchen had awarded it a five star rating. Bedrooms that we saw were highly personalised and attractive. During 2009 an additional room, with its own kitchen and bathroom facilities, was built onto the home and registered. This has enabled a person to receive a mix of some services from the home, and some from outside domiciliary support. The person told us how they continued to look after themselves in lots of ways. They also enjoyed the company of people in the home when they chose. They felt safe at night and appreciated the support of home staff in their morning routines. They had chosen the colour scheme and soft furnishings in their rooms, and had been able to take time to visit the home and make up their mind it would be the right place for them. We saw that Sharon Arnott had liaised closely with others to carry out a full assessment of the person`s needs so they could be sure the home could meet them. The same was true for a person who was re-admitted to the home from a hospital stay, when their physical care needs had changed significantly. Care plans were based on pictorial skills assessments and risk assessments. They helped people identify goals they wished to achieve, as well as aspects of life where they needed some support. People signed theirplans, which were regularly reviewed. We saw that people were consistently offered choices, and able to make decisions about everyday matters. People chose how they spent their time. They were supported to discuss things together, particularly at the meal table. People`s key workers helped them prepare for house meetings if they wished, so these were valuable sharing meetings. Staffing was arranged to help ensure people were supported in individual choices to attend clubs and day resources and to go out into the community as they chose. People were able to plan holidays and day trips. We saw ways in which people were encouraged to actively maintain friendships. The consequences of ageing for some people living in the home have become greater over the three years since we last visited. Support plan reviews took account of this. There were many examples of the home maintaining strong links with external health professionals. This meant people received medical attention when they needed it, as well as routine health checks. Two people from the home had experienced hospital admissions within the previous year. In each case the home provided a `hospital passport` as a means of providing hospital staff with maximum person-centred information to assist them to care for the person. Staff and people that live in the home maintained a lot of contact with people whilst they were in hospital. There was significant experience in the home of capacity and consent assessments being carried out in relation to health matters. All staff received annual refresher training regarding abuse awareness, and their role in relation to the Mental Capacity Act 2005. The home retains a largely stable staff team. Five support workers responded to our postal survey. All gave consistently positive responses to questions about the regularity and quality of training and supervision, and considered they received good information about the people they supported. Two of the five considered there were `always` enough staff to meet the needs of all the people that use the service. Three indicated that there `usually` were. Willow House is accredited as an `Investor in People`, which shows recognised benchmarks have been maintained regarding commitment to effective staff training. Duties for one member of staff include the role of training co-ordinator. Most support workers had achieved level 3 in NVQ [National Vocational Qualification] in care, with some progressing to level 4 and one to the Leadership and Management Award. We saw evidence that applicants for employment were observed in their interactions with people living in the home. Individual supervision of staff was frequent and well organised. Some members of staff told us of the use of role play within staff meetings. Staff commented on the inclusive nature of Sharon Arnott`s management style. For example, staff opinions had been canvassed about development and use of the additional room, and about re-admission of a person whose physical care needs had increased. Sharon Arnott delegated to the strengths of individual staff members. She also remained close to and involved in the direct support of people living in the home. A staff member wrote in our survey `the manager leads by example in matters of both care and admin.` What has improved since the last inspection? The sitting room in the home had been redecorated in neutral colours in consultation with people living in the home. This gave it a much more modern feel than previously, partly as there was now a wall-mounted large screen television. Space through the centre of the room had been increased to facilitate passage for people using walking aids or wheelchair. For some people there had been some work on increasing the pictorial content of care plans. The use of medicines had increased in the home. They had introduced a way of making sure the member of staff supporting people with taking medicines would not be disturbed or distracted by other duties. In response to a recommendation we made at our previous inspection, Sharon Arnott was maintaining a record of minor matters of complaint and how they had been addressed. This showed that any concern was treated seriously and received a rapid response to put it right, or to give an explanation. It also assisted monitoring of quality issues in the home. It meant issues were resolved without assuming the status of formal complaint. A visit by Wiltshire Fire and Rescue Service in March 2010 had resulted in a number of recommendations for increasing fire safety. We saw that these were each receiving attention. What the care home could do better: No requirements have been set at this inspection. We have made some recommendations for good practice. Risk assessments in people`s care plans were performing their function, but could be written in more person-centred ways that would also allow them to be evaluated more accurately. Some people were at an increased risk of sustaining pressure damage because they were becoming older and less physically active. The home should assess these risks and decide a plan of care to reduce any risk identified. We received seven survey forms from people who live in the home. They all indicated they had been completed with staff assistance. We would prefer that efforts were made to identify supporters outside the home who could provide this assistance, to demonstrate independence. Key inspection report Care homes for adults (18-65 years) Name: Address: Willow House 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT     The quality rating for this care home is:   three star excellent 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: Roy Gregory     Date: 2 0 0 4 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 32 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 32 Information about the care home Name of care home: Address: Willow House 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT 01980622220 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sharonarnott@tiscali.co.uk Glen Arnott,Sharon Anne Arnott Name of registered manager (if applicable) Sharon Anne Arnott Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 9. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Willow House is a semi-detached house that has been extended over the years. It has single bedrooms, over three floors, for nine people with a learning disability. One room has an en-suite bathroom and another has both a shower room with toilet and fully equipped kitchen. The other rooms have bathrooms and toilets nearby and some have wash hand basins. There is a sitting room and a modern conservatory, which has two dining tables. Patio doors lead out to the pleasant rear garden, which overlooks open countryside. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 9 Brief description of the care home The home is on the northern edge of Amesbury, in a road of similar houses. It is not far from the A303 trunk road between London and the West Country. It is easy to catch a bus to Amesbury or Salisbury. The home has a car to help people get about, and some people like to walk into Amesbury town centre. The front garden is used for car parking. The registered manager is also the co-owner (with her husband) of the business. Weekly fees are set in accordance with the Wiltshire Council fair pricing tool. Fees do not include items such as transport, toiletries, newspapers, podiatry and social outings. There is a service users guide provided to people living there, and their relatives, to help explain how support is provided, what services they can expect and what additional costs they will have to meet. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent 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: We visited Willow House between 1:30 p.m. and 8:15 p.m. on Tuesday 20th April 2010. Sharon Arnott, the registered manager and provider of the service, was available during all this time. We also met with members of support staff who were on duty, and the homes administrator. All the people that live in the home returned from their various activities during the afternoon. We were able to spend time talking with people, singly and together at their evening meal. We saw all the shared areas of the home, and four people showed us their bedrooms. We looked at some peoples care and support plans. We saw how staff wrote about the work they did, and how the manager checked that things were done on time and to a good standard. We looked at risk assessments and fire precautions, to make sure the home was run to keep people safe. We saw how medication was used and how the home linked up with health professionals and other community resources. As the home had recently conducted a questionnaire exercise with people in the home, their Care Homes for Adults (18-65 years) Page 6 of 32 relatives and external professionals, reference was made to responses that had been received. Staff records showed us how new staff were recruited in the past year, and how all staff received training and supervision. We were able to observe how staff worked with the people living in Willow House. Minutes of staff and residents meetings also gave us a flavour of how management, staff and people in the home worked together. Sharon Arnott conducted a survey every year of how people in the home, and their relatives and visitors, felt about the service the home provides. We looked at the results of the most recent survey. We also carried out our own postal survey of the views of people living at the home, and of some of the staff. We took into account annual service reviews that we carried out in the three years since our previous inspection visit. We received the services AQAA [Annual Quality Assurance Assessment]. This is a self-assessment that focuses on how well outcomes are being met for people using a service, and how the management intend to develop their service further. It also contains some numerical information. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: Our survey and the homes own survey showed very high levels of satisfaction with the home. The AQAA showed that staff and people living in the home were routinely consulted about how things were done, and what changes they might like to try. All parts of the home appeared well maintained and clean to a good standard. There was an annual plan for regular spring cleaning of bedrooms and shared rooms. Monitoring records showed this was adhered to. An environmental health inspection of the kitchen had awarded it a five star rating. Bedrooms that we saw were highly personalised and attractive. During 2009 an additional room, with its own kitchen and bathroom facilities, was built onto the home and registered. This has enabled a person to receive a mix of some services from the home, and some from outside domiciliary support. The person told us how they continued to look after themselves in lots of ways. They also enjoyed the company of people in the home when they chose. They felt safe at night and appreciated the support of home staff in their morning routines. They had chosen the colour scheme and soft furnishings in their rooms, and had been able to take time to visit the home and make up their mind it would be the right place for them. We saw that Sharon Arnott had liaised closely with others to carry out a full assessment of the persons needs so they could be sure the home could meet them. The same was true for a person who was re-admitted to the home from a hospital stay, when their physical care needs had changed significantly. Care plans were based on pictorial skills assessments and risk assessments. They helped people identify goals they wished to achieve, as well as aspects of life where they needed some support. People signed theirplans, which were regularly reviewed. We saw that people were consistently offered choices, and able to make decisions about everyday matters. People chose how they spent their time. They were supported to discuss things together, particularly at the meal table. Peoples key workers helped them prepare for house meetings if they wished, so these were valuable sharing meetings. Staffing was arranged to help ensure people were supported in individual choices to attend clubs and day resources and to go out into the community as they chose. People were able to plan holidays and day trips. We saw ways in which people were encouraged to actively maintain friendships. The consequences of ageing for some people living in the home have become greater over the three years since we last visited. Support plan reviews took account of this. There were many examples of the home maintaining strong links with external health professionals. This meant people received medical attention when they needed it, as well as routine health checks. Two people from the home had experienced hospital admissions within the previous year. In each case the home provided a hospital passport as a means of providing hospital staff with maximum person-centred information to assist them to care for the person. Staff and people that live in the home maintained a lot of contact with people whilst they were in hospital. There was significant experience in the home of capacity and consent assessments being carried out in relation to health matters. All staff received annual refresher training regarding abuse awareness, and their role in relation to the Mental Capacity Care Homes for Adults (18-65 years) Page 8 of 32 Act 2005. The home retains a largely stable staff team. Five support workers responded to our postal survey. All gave consistently positive responses to questions about the regularity and quality of training and supervision, and considered they received good information about the people they supported. Two of the five considered there were always enough staff to meet the needs of all the people that use the service. Three indicated that there usually were. Willow House is accredited as an Investor in People, which shows recognised benchmarks have been maintained regarding commitment to effective staff training. Duties for one member of staff include the role of training co-ordinator. Most support workers had achieved level 3 in NVQ [National Vocational Qualification] in care, with some progressing to level 4 and one to the Leadership and Management Award. We saw evidence that applicants for employment were observed in their interactions with people living in the home. Individual supervision of staff was frequent and well organised. Some members of staff told us of the use of role play within staff meetings. Staff commented on the inclusive nature of Sharon Arnotts management style. For example, staff opinions had been canvassed about development and use of the additional room, and about re-admission of a person whose physical care needs had increased. Sharon Arnott delegated to the strengths of individual staff members. She also remained close to and involved in the direct support of people living in the home. A staff member wrote in our survey the manager leads by example in matters of both care and admin. What has improved since the last inspection? What they could do better: No requirements have been set at this inspection. We have made some Care Homes for Adults (18-65 years) Page 9 of 32 recommendations for good practice. Risk assessments in peoples care plans were performing their function, but could be written in more person-centred ways that would also allow them to be evaluated more accurately. Some people were at an increased risk of sustaining pressure damage because they were becoming older and less physically active. The home should assess these risks and decide a plan of care to reduce any risk identified. We received seven survey forms from people who live in the home. They all indicated they had been completed with staff assistance. We would prefer that efforts were made to identify supporters outside the home who could provide this assistance, to demonstrate independence. 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 10 of 32 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 11 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed so that they are only offered a place if their needs can be met. They are given good information, and the chance to visit and stay overnight, to help them decide if the home is right for them. Evidence: During the previous year an additional room, with facilities to enable a semiindependent lifestyle, was built onto the home and registered. This has enabled consideration of a more flexible way of providing care and support. There was exploration of the possibility of a move into this room for a person living in the home, including an assessment of needs with them. However, a closer match of need and provision was made by admitting a person from another care setting. This person receives external domiciliary support to sustain a large measure of independent living, whilst benefiting from some social activity, including sharing some meals, with people in the home. The home also provides for the persons security at night, and supports their morning personal care needs. The person admitted told us they made a number of visits to the home before deciding Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: definitely on moving in. This period enabled them to be involved in planning how to make the most of the accommodation and different sources of support. They felt well supported by this process. There was evidence the home worked closely with the Community Team in agreeing the nature of care package to be provided. We could see that the separate home and domiciliary care inputs were being sustained as had been planned, thus maintaining the persons skills and motivation to live an independent lifestyle. A senior member of the Community Team has told us of the teams high regard for the professional and individualised service available from Willow House. A person resident in the home was admitted to hospital in 2009 and presented a number of changed support needs, particularly in respect of mobility. They wished to return to Willow House. There was a re-assessment process to determine whether their needs could continue to be met by the home. Outreach services, including consultant psychologist and psychiatrist, were involved in assessment and in helping to re-configure the persons care plans to enable a return to the home. Members of staff told us how they had also been consulted as a staff group about whether it was feasible to re-admit the person, given the additional direct care tasks that would be presented. Work was ongoing with one person in order to increase their choices of accommodation, as it was thought they may benefit from moving to live with a younger peer group. We saw work in progress on a new pictorial brochure for the home, which was aimed more at people likely to make referrals than people who might wish to live there. The service user guide was a readable document that contained essential information. It explained in simple terms how support is provided, what services people can expect and what additional costs they will have to meet. When someone is admitted, they are given a personalised version of the guide to show the room occupied and the persons key worker, together with details about the contract for their stay. A copy is given to their representative. The service users guide is also displayed in the homes front hall, with the statement of purpose and a copy of the most recent inspection report. Amendments made to the service users guide and the statement of purpose showed they were maintained as up to date. Care Homes for Adults (18-65 years) Page 13 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs and goals are assessed and reviewed through a planning system that promotes recognition of rights and abilities to make choices. People are actively involved in making decisions, individually and as a group. Risks are recognised and minimised to enable participation in every day life experiences. Evidence: Peoples care and support plans followed a common format, which identified areas of daily living where support was needed and developed a plan of care for each of these. There was good cross-referencing between different parts of peoples care plans. For a person with complex needs, there was very specific instruction on how to carry out some care functions. This ensured the person received care in line with their known preferences, for example about times of day, whilst also ensuring their safety and comfort, for example when using certain equipment. For a person with particular communication needs, their plan gave clear guidance on how to engage with them, based on experience and outside professional advice. We could see that this persons confidence in verbal communication had increased since our previous visit. Care plans Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: emphasised a person-centred approach, to include respect for diverse needs. They drew on pictorial skills assessments, which were regularly reviewed and helped people identify goals they wished to achieve. People had signed their support plans. There was evidence of meaningful monthly review. There were personal profiles for every service user. These were completed with peoples direct involvement and pictorial personal statements had been completed for some people for individual reasons. People had their own key workers, who took responsibility for involving people and maintaining their care plans. We also saw that the home was successful in securing care manager reviews of peoples placements. Observations of staff interactions showed that people were consistently offered choices, and able to make decisions about everyday matters. We saw that people in the home chose how they spent their time, including making use of the shared rooms and their private rooms. They were supported to discuss things together, particularly at the meal table, and also had monthly house meetings. Staff kept daily records for each person living in the home. These were objective and showed that care plan directions were followed. They demonstrated staff awareness of the things that were important to people. Support plans included individual risk assessments filed with the relevant parts of the plan. Whilst these ensured an appreciation of responsible and facilitated risk taking, we discussed ways in which they could be made more person-centred. The forms could be simplified and made more amenable to evaluation. Sometimes it was unclear what risks had been identified. Care Homes for Adults (18-65 years) Page 15 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Varied activities give people access to the community and opportunities to develop skills and leisure interests within the home, local community and wider area. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. Menus are varied and service users can choose the food they prefer. Evidence: All support plans identified peoples preferred activities and aimed to facilitate access to resources that fitted with their social needs and interests. People attended various clubs and day resources. There were appropriate staffing arrangements to ensure individual choices could be supported. Funding had been obtained for a person with restricted mobility to enjoy community access twice a week with staff support by use of a wheelchair taxi. For others, staff sometimes drove their own or the homes car, but there was also much support to people to use public transport. The homes car Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: was particularly useful for facilitating holidays. There were regular house meetings, of which minutes were kept. Participation in these had been increased by means of a pre meeting questionnaire that key workers could support people with. These helped ensure everyone had a voice in the meetings, and also prompted key workers to check peoples understanding of concepts such as the complaints procedure. Meetings were used to promote the homes Be Kind motto as something that underpinned how people wished to respect each other. A General Election was forthcoming at the time of our visit. All people in the home were registered to vote and were to be supported in choosing whether to exercise their vote. Six people had holidays planned for 2010, in small groups or with one-to-one staff support. Sharon Arnott had been able to access some external holiday funds for some people. Three people had been assessed as unlikely to be well enough to benefit from a holiday, although there were contingency plans. For those three there was a commitment to individual day trips and we saw some of the planning that went into these. Care plans included facilitating contact with peoples families and friends. Records showed various ways in which the home and peoples families had worked together on different issues for the benefit of individuals in the home. Feedback from families through the homes own quality questionnaire showed this was valued and that visitors experience the home as open and welcoming. We also saw ways in which people were encouraged to actively maintain friendships. Peoples care plans included guidance on support to people to take responsibility for cleaning their rooms, helping with kitchen chores and managing laundry. The person in the semi-independent room had a cooker, fridge and laundry appliances provided with their accommodation and were thus able to retain a great deal of independence. People were invited to join a menu planning group with a consistent member of staff each week. This resulted in the agreed weeks menu being displayed on a notice board. Every day the menu for that day was also displayed, in an effective pictorial form. The main venue for meals was the conservatory, which contained two dining tables. People usually chose to eat their evening meal together. Staff on duty ate with the people that live in the home. If someone had eaten a main meal elsewhere at lunch time, they could choose to have a sandwich or other alternative. Sometimes people chose to eat out of doors in fine weather. One person sometimes chose to eat Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: in their room, in which case a member of staff would sit with them there. Main meals were plain but substantial. It was a support staff duty to cook, with varying degrees of assistance from people living in the home. People who took packed lunches were very involved in preparing them. After the evening meal we saw that some people settled in front of the television in the sitting room, some went to their bedrooms or visited each other. In a persons room there was a weekly chart they filled in with their key worker as a reminder of what they had planned for different days. Care Homes for Adults (18-65 years) Page 18 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care in ways they prefer. Peoples health needs are assessed and monitored, with close liaison with health professionals as necessary. People are protected by the services policies and procedures for handling medicines. Evidence: The consequences of ageing for some people living in the home have become more pronounced over the three years since we last visited. Support plan reviews took account of this. For example, morning staffing arrangements had been altered to ensure support was available at the right time to a person requiring the assistance of two staff. We saw that a physiotherapist had provided training input about this persons moving and handling needs. A hospital bed and mattress had also been provided. There were many other examples of the home maintaining strong links with external health professionals. As a result, it was also clear that the observations and opinions of Sharon Arnott and her staff were valued by these other professionals. This meant people received medical attention when they needed it, as well as routine health checks. We saw an example of a Health Action Plan. This showed how identified actions for the person were to be planned, and by whom. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Where appropriate, epilepsy profiles were completed by specialist learning disability nurses, who also provided staff with training about epilepsy and the use of rescue medications. We saw an example of a persons epilepsy profile and intervention plan, which included a recovery medication protocol. All members of staff had signed acknowledgement that they had received and understood the related training. Another area of externally provided training concerned administration of enemas. Sharon Arnott had negotiated an agreement with the community nursing service about provision of training and signing off staff competency. The person receiving this treatment had been subject of a best interest review of the need for enemas. Two people from the home had experienced hospital admissions within the previous year. In each case the home provided a hospital passport as a means of providing hospital staff with maximum person-centred information to assist them to care for the person. One person was currently in hospital for an orthopaedic operation. Staff from the home were visiting daily, often taking people from the home who wished to visit. The persons daily record of care was being kept up at the home. Therefore the home would have a good knowledge and understanding of changes and issues when the person returned home, and the person experienced continuity of familiar care. As some people were becoming more sedentary, there was recognition of a risk of pressure ulceration for some people, but no specific risk assessments were in place to ensure pro-active risk reduction. We recommend that a recognised assessment tool should be sourced, leading to a care plan for prevention of pressure damage for any person where a medium or high risk is identified. We have also drawn attention to the Department of Health guidance about risk assessment in the use of bed rails, which may be applicable for one person in the home. Peoples medicines were kept in locked cabinets within their own rooms, together with the records of administration of medicines. This meant people received support to taking medicines on an individual basis, with reduced risk of errors. People signed agreement to receive such support. Records of administration that we saw were in good order. The use of medicines in the home had increased, but there was evidence of reviews of prescribing by both the GP and PCT pharmacist. The person administering medicines at any time wore a distinctive tabard to emphasise they were engaged in a concentrated task and were not to be disturbed. All people in the home were fully aware of this. There was evidence that the PCT pharmacists advice had been sought on a number of matters, including some adjustment to the homes medication policy. Two senior care staff had been adjudged by the pharmacist as competent to assess the competency of Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: other staff to administer medicines, which was renewed six monthly at the request of staff and recorded. Staff had undertaken a distance learning course about medications, provided through a local college. Two senior staff members took responsibility for re-ordering and checking in medicines. The home was about to trial an on-line ordering service from a different supplier. Sharon Arnott believed this would provide a sounder audit trail. Care Homes for Adults (18-65 years) Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. Evidence: Before each monthly house meeting, people were given a sheet they could use to help them to make comments, with the assistance of key workers, if they wished. The form drew attention to the possibility of voicing any complaint or concern, through the meeting or elsewhere. In response to a recommendation we made at the previous inspection, Sharon Arnott was maintaining a record of minor matters of complaint and how they had been addressed. This showed that any expression of dissatisfaction was treated seriously and received a rapid response to put it right, or to give an explanation. Together with other avenues of every day communication in the home, this meant issues were resolved without assuming the status of formal complaint. The home had pictorial guidance, and a flow-chart, displayed in the entrance hall to assist understanding of the complaints procedure. No complaints had been made through the formal procedure. Individual care plans included support plans for how people managed personal monies. These gave specific individual guidance and showed the limitations of support that staff could give. Some tasks were limited to involvement by Sharon Arnott or senior staff. Most people chose to have a weekly meeting with a member of staff to check their current availability of cash, which also enabled staff to check the accuracy Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: of records. Two service users personal financial records were audited annually within the homes annual accounts audit. All staff received annual refresher training regarding abuse awareness, and their role in relation to the Mental Capacity Act 2005. There was significant experience in the home of capacity and consent assessments being carried out in relation to health matters. Information was readily available about the local inter-agency safeguarding procedures, which were introduced to all new staff within induction. Internal incident forms, and notifications to us, demonstrated that staff are observant and keep objective records. We saw that for one person there was a behaviour support plan. This was based on recognition that their behaviours represented communication about anxiety and therefore were to be responded to in that context. All staff who responded to our survey indicated that they were confident of what to do if they or anyone else had concerns about the home. Care Homes for Adults (18-65 years) Page 23 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Willow House provides a homely environment, maintained and kept clean to a high standard. Individual bedrooms reflect peoples needs and lifestyles. Evidence: In June 2009 we registered an additional room that was built on to the home. This has the benefit of a small kitchen and its own shower and toilet, allowing the occupant to live a very independent lifestyle. It also has its own front door, as well as direct access to a corridor in the main home. The person living there confirmed the choices of decor and flooring were theirs, and they had also specifically asked for the blinds in place of curtains in all their windows. They felt they had full control over how they used their room. Their front door was important to them personally, and also meant their domiciliary support workers came in and out with no need to go through the home. In the evening, however, they appreciated mixing with people in the home, and often left their internal door open to feel part of the wider home. There was a call bell installed in their room in case they should need to summon staff assistance at night. The sitting room in the home had been redecorated in neutral colours in consultation with people living in the home. This gave it a much more modern feel than previously, partly as there was now a wall-mounted large screen television. Space through the centre of the room had been increased to facilitate passage for people using walking Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: aids or wheelchair. Bedrooms that we saw with peoples agreement were highly personalised and attractive. Space constraints in the home, and the need for staff to have ready access to some documentation, meant one end of the sitting room accommodated a cabinet and notice board. The cabinet had been chosen to fit in with a living room environment, and was not specifically office furniture. All parts of the home appeared well maintained and clean to a good standard. There was an annual plan for regular spring cleaning of bedrooms and shared rooms. Monitoring records showed this was adhered to. An environmental health inspection of the kitchen had awarded it a five star rating. People were involved to varying degrees in managing their laundry, including ironing, and in cleaning their bedrooms and other parts of the home. There was a laundry room with modern equipment. For risk-assessed reasons, people living in the home did not use the laundry room unless accompanied by staff, but it was available any time. Sharon Arnott agreed our observation that a notice board with care-related information in the laundry room was inappropriately placed because of confidentiality issues. She and the administrator undertook to produce and locate the displayed information differently. Care Homes for Adults (18-65 years) Page 25 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Evidence: The home retains a largely stable staff team. Five support workers responded to our postal survey. All gave consistently positive responses to questions about the regularity and quality of training and supervision, and considered they received good information about the people they supported. Two of the five considered there were always enough staff to meet the needs of all the people that use the service. Three indicated that there usually were. Willow House is accredited as an Investor in People, which shows recognised benchmarks have been maintained regarding commitment to effective staff training. Duties for one member of staff included the role of training co-ordinator. Sharon Arnott has invested significantly in a distance learning resource that provides staff with certificated renewable training as it becomes due. All courses included marking of written tests in-house and externally by the training provider. The home maintained an annual training plan that ensured staff remained in-date with all training. There was an expectation that staff would attain National Vocational Qualification [NVQ] in Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: care to at least level 2. In fact most had achieved level 3 and some of those were working towards level 4. A senior care worker had reached NVQ level 4 and had embarked on the Leadership and Management Award. Staff records were well organised. In the case of recruitment of staff, it was easy to track the process from initial application to appointment. All staff had been subject of checks by the Criminal Records Bureau and take-up of two references prior to being appointed. Induction of new staff was in line with recognised core induction standards. We saw evidence that applicants for employment were observed in their interactions with people living in the home. Feedback from people in the home was also obtained when new staff completed their initial probationary period. Senior staff gave regular one-to-one supervision to support staff, and were in turn supervised by Sharon Arnott. A pre-supervision form was used, so staff were prepared for a meaningful exchange. Full time staff received monthly supervision and for parttime staff it was on alternate months. Supervision included consideration of training needs, experience of training received, perceptions of the effectiveness of key work, and personal issues. There were good records of supervision. Staff meeting minutes showed they too were used to share experiences of the care and support role and the needs of individual people in the home. Some members of staff told us of the use of role play within team meetings to model different interventions, which they found very effective. Care Homes for Adults (18-65 years) Page 27 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team provides leadership and direction so people benefit from a well run home. There are systems for monitoring and improving the service provided, based on direct feedback from people that have a stake in the service. There are a number of measures in place to promote and protect the health and safety of people that live and work in the home. Evidence: Staff commented on the inclusive nature of Sharon Arnotts management style. For example, staff opinions had been canvassed about development and use of the additional room, and about re-admission of a person whose physical care needs had increased. Sharon Arnott delegated to the strengths of individual staff members, so she could develop a more strategic role. However, she also remained close to and involved in the direct support of people living in the home. An administrator had been appointed in recent months, as an addition to the staff team. Our communications with and from the home show it as open and responsive. Sharon Arnotts completion of our required Annual Quality Assurance Assessments showed insight and a proactive approach to the management task. A staff member wrote in our survey the Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: manager leads by example in matters of both care and admin. Staff meetings were held most months. Members of staff signed the minutes to show they had seen them. Minutes showed that any matters raised in the residents meetings were carried forward into the staff meeting. A quality assurance questionnaire exercise was undertaken annually. For people living in the home there was a colourful, pictorial questionnaire that allowed for indication of answers, with space for additional comment if required. Another format was used to seek views from peoples family contacts and others. People were invited to rate various aspects of the home on a scale of one to five. We saw the results of the survey undertaken in 2009. There were many very positive responses and some additional written compliments. A written analysis showed that any comments, and any scores of less than five, were considered further and addressed as appropriate. Peoples relatives were kept informed of news in the home by occasional newsletters. We received seven survey forms from people who live in the home. They all indicated they had been completed with staff assistance. We would prefer that efforts were made to identify supporters outside the home who could provide this assistance. A monthly quality audit tool showed active monitoring of all aspects of managing the home, checking for example formal staff supervision, reviews of care plans and environmental issues. Any issues for attention were readily identified this way. The office contained an annual plan to ensure monthly, quarterly and annual tasks were accomplished. This covered a range of matters, including care plan reviews, boiler servicing, fire precautions checks and medicines audit. There were good systems in place for monitoring and attending to health and safety matters. There was a record of quarterly fire training for residents and staff. Care plans included individual fire alarm response plans. Staff received training in manual handling, first aid, food hygiene and infection control. Staff who were drivers were permitted to take people out in their cars, subject to proof of satisfactory insurance cover. A visit by Wiltshire Fire and Rescue Service in March 2010 had resulted in a number of recommendations for increasing fire safety. We saw that these were each receiving attention. There was a fire evacuation plan in the staff sleep-in room. There were arrangements for periodic repeat practicing of evacuation of the building. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 19 Risk assessments should be used more purposefully as a person-centred planning tool. People should be individually assessed for risk of pressure ulceration, and a care plan for risk reduction implemented in response to any identified risk. Continue to minimise the siting of administrative items or information in shared areas of the home. When people supported by the home are invited to express their views on the quality of service they receive, try to identify independent trusted people who might assist them. 3 4 24 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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