Care Home: Willow House - City of York Council

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What the care home does well People are always assessed before they are admitted, so the home can get a good idea about whether it will be able to meet the person’s needs. People, in turn, are given information about the home so they too can decide whether the home will be right for them.Willow House - City of York CouncilDS0000034914.V377219.R01.S.docVersion 5.2People are cared for by courteous, caring staff who know about their individual needs. The approach to care is flexible, so people’s lives are not limited by any routines at the home. People can make decisions about what they do during the day, and can have their visitors whenever they want them. This helps to maintain their independence, and social links with those who are important to them. People like the food, which they say is good and hot, and provides them with some choice. Staff get a range of training so they know how to work safely when supporting people. They take people’s concerns and welfare seriously, and know that they must pass on these concerns. This helps to protect people from abuse. People’s views are taken into account with regards to the running of the home. This helps to make sure that it is run in their best interests. What has improved since the last inspection? The staff have worked hard to make care plans more personal. They are beginning to describe people’s needs in an individual way, so that it is easier to see how one person’s needs differ from the next. Some improvements have been made to the way that medication is handled, so that the systems are safer for people. Although further improvements are needed. More advertised activities have been organised so people can plan ahead what they wish to attend. People have been asked whether the activities at the home meet their needs. The registered manager is looking at their comments, to see where further changes are needed. Some improvements have been made to the decorations in certain areas of the home. This will make it more pleasant and comfortable for people. What the care home could do better: Information about people’s care, and any risks associated with that care, could be clearer in their care plan. This would help to make sure that staff always work consistently and safely when providing this care. Some improvements could be made to the way people’s medication is managed, so that the risk from error is kept to a minimum. More care could be taken to stop the spread of fire at the home. More staff would mean that more time could be spent with people, in particular pursuing both group and individual activities which interest them.Willow House - City of York CouncilDS0000034914.V377219.R01.S.doc Version 5.2 The registered manager could record minor concerns reported to her as well as formal complaints. This way she would have evidence to show how she has resolved these. Doing so would also allow her to check whether there were any common ‘grumbles’ that she may need to look into further. The ventilation from the smoke lounges could be checked to make sure they are extracting as they should, and leaving other areas of the home free from the smell of tobacco smoke. The manager could check why prospective staff have gaps in their employment where these have not been explained. This would make sure that these gaps are not connected in any way to them being unsuitable to work with vulnerable people. Staff could be provided with some training around mental health matters, so they have a broader knowledge around the conditions that some people living at the home have. This would further enhance the aims of the home, in making care very individual and person centred. Key inspection report CARE HOMES FOR OLDER PEOPLE Willow House - City of York Council Willow House Long Close Lane Walmgate York North Yorkshire YO10 4UP Lead Inspector Anne Prankitt Key Unannounced Inspection 8 September 2009 09:30 DS0000034914.V377219.R01.S.do c 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 homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Willow House - City of York Council DS0000034914.V377219.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 - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow House - City of York Council Address Willow House Long Close Lane Walmgate York North Yorkshire YO10 4UP 01904 630 437 01904 466232 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) www.york.gov.uk City of York Council Mrs Joyce Handy Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th September 2008 Brief Description of the Service: Willow House is a care home on two floors, which was purpose-built about 40 years ago and is run by City of York Council. The home provides personal care for older people. Willow House is situated less than fifteen minutes walk from the centre of York, inside the historic city walls, and with Walmgate Bar close by. There are small shops and a public house within a short walking distance. Bedrooms are located on both floors, with a passenger lift to aid access. The gardens have seating areas and there is a new patio with a conservatory overlooking Walmgate Bar and the Bar Walls. The registered manager told us on 8 September 2009 that the weekly fees range from £73.55 to £469.14. People pay extra for hairdressing, private chiropody, newspapers and magazines. The service provides an information booklet about the home to people thinking of using the service. Information in the statement of purpose, service user guide and last inspection report written by our predecessor, the Commission for Social Care Inspection, is available to people on request from the registered manager, to help them make a decision about whether the home is the right place for them. Willow House - City of York Council DS0000034914.V377219.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 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comments cards completed and returned by nine people who live at the service, and four staff who work there. A site visit to the home, carried out by one inspector over approximately eight hours on 9 September 2009. • • During the visit to the home, several people who live there, visitor, some staff, and the registered manager were spoken with. Four people’s care plans were looked at in detail, as well as two staff recruitment files, some training records, and some health and safety information. Care practices were observed where appropriate, and time was spent watching the general activity, to get an idea about what it is like to live at Willow House. The registered manager was available throughout the day, and she was provided with feedback at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only where it is considered that people who use the service are no0t being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People are always assessed before they are admitted, so the home can get a good idea about whether it will be able to meet the person’s needs. People, in turn, are given information about the home so they too can decide whether the home will be right for them. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 6 People are cared for by courteous, caring staff who know about their individual needs. The approach to care is flexible, so people’s lives are not limited by any routines at the home. People can make decisions about what they do during the day, and can have their visitors whenever they want them. This helps to maintain their independence, and social links with those who are important to them. People like the food, which they say is good and hot, and provides them with some choice. Staff get a range of training so they know how to work safely when supporting people. They take people’s concerns and welfare seriously, and know that they must pass on these concerns. This helps to protect people from abuse. People’s views are taken into account with regards to the running of the home. This helps to make sure that it is run in their best interests. What has improved since the last inspection? What they could do better: Information about people’s care, and any risks associated with that care, could be clearer in their care plan. This would help to make sure that staff always work consistently and safely when providing this care. Some improvements could be made to the way people’s medication is managed, so that the risk from error is kept to a minimum. More care could be taken to stop the spread of fire at the home. More staff would mean that more time could be spent with people, in particular pursuing both group and individual activities which interest them. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 7 The registered manager could record minor concerns reported to her as well as formal complaints. This way she would have evidence to show how she has resolved these. Doing so would also allow her to check whether there were any common ‘grumbles’ that she may need to look into further. The ventilation from the smoke lounges could be checked to make sure they are extracting as they should, and leaving other areas of the home free from the smell of tobacco smoke. The manager could check why prospective staff have gaps in their employment where these have not been explained. This would make sure that these gaps are not connected in any way to them being unsuitable to work with vulnerable people. Staff could be provided with some training around mental health matters, so they have a broader knowledge around the conditions that some people living at the home have. This would further enhance the aims of the home, in making care very individual and person centred. 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 - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. People’s needs are assessed before they are admitted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Before people are admitted, the registered manager visits them to carry out a pre admission assessment. This helps everyone to decide whether the home can provide the right care, and has the right resources, to meet their needs. As part of this assessment, she writes down some basic information about their care requirements. She also collects information from their care manager, or from the hospital, if they are being admitted from there, and considers this information also. People and their families are also welcome to visit the home themselves. This gives them the opportunity to meet other people who live there, and the staff who may care for them in the future. Everyone is also given written Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 10 information about the home. This gives people the opportunity to see for themselves whether Willow House is somewhere they would like to live. Of the nine people who returned their surveys, seven of these said that they received enough information to help them decide whether the home would be right for them. Two people did not know. Staff spoken with said they got enough information about people’s needs so that, when people arrived, they could start to provide them with the right care straight away. The home does not provide intermediate care. However, people can stay at the home for short breaks, called respite care. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience adequate quality outcomes in this area. People are happy with their care, but their care plans and risk assessments do not always confirm how this is to be delivered safely and consistently. Some improvements to the medication systems are needed to reduce the risk from errors happening. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Following a person’s admission, the staff complete a care plan, which describe what needs they have, and how staff should meet them. People had not signed their care plan, although a staff member said that this is discussed each month with them when their care is reviewed at the home. There was evidence that the information collected before the admission took place was considered. However, staff do need to make sure that important information provided by the care manager is not overlooked when developing the care plan, and any risk assessments associated with their care. For instance, a person recently admitted had a history of falls before they arrived. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 12 However, staff said in their own documentation that there was no risk in this area for the person concerned. In some cases, information in people’s risk assessments had not been transferred to their care plan. This meant that, sometimes, the two pieces of information did not match, or were confusing. For instance, two people’s risk assessment showed that they were at risk from pressure damage. However, they had not been provided with a special mattress to prevent any damage to their skin. The registered manager said that this decision had been discussed and agreed with the District Nurse. This sort of information, along with what signs staff should look out for which would tell them when they need to contact the District Nurse again, should be included in the care plan. This would help to make sure that the right professionals have input into the person’s care as soon as it is needed. Another risk assessment suggested that alternative dining arrangements were in place for one person. However, the care plan did not make any reference to this, and the arrangements described in the risk assessment were not being carried out. The registered manager said that this arrangement was no longer needed. However, this could cause confusion if staff who did not know the home so well were to follow the guidance written in the person’s notes. Instructions in a risk assessment about medication, which agreed that the staff should check the person’s room regularly, had not been included in the persons care plan about medication, which made no reference to how often this should be done, or whether in fact the instructions were being followed. Another care plan stated that staff look after the person’s medication. However, they had a risk assessment stating that they manage their own inhalers. Neither pieces of information were correct, as staff supervise the person to take this medication, which the person does not keep themselves. It was not clear whether one person had suffered some weight loss, as the record of their weight suggested they had, but the care plan said that they had a good appetite, and made no reference to this area of risk. This needs to be followed up, and advice sought from the appropriate health professional if the person has indeed lost weight as the records suggests is the case. Staff said they have worked hard over the past year to make the care plans more individual. They told us that they get reports each shift about people’s care. Those staff who returned their surveys agreed that the way information is shared about people ‘always’ or ‘usually’ works well. They have developed life profiles, which give lots of information about the person’s individual preferences in their daily lives. They are undergoing training to help them do this. The care plans could be more detailed still, although discussion with staff showed that they know people’s needs well. There were some good examples, Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 13 especially in relation to people’s mental health and emotional needs, where their care was described in a very individual way. And a recent example showed they had acted quickly by reporting to the right professional changes in the person’s health, as they had been instructed to do. Of the people who replied to the questions asked in their surveys, seven out of eight of these said that they ‘always’ get the care and support that they need. One said this was ‘usually’ the case. Four out of seven said that staff ‘always’ listen and act on what they say, and three said this was ‘usually’ the case. Of the seven who answered, all said that the home makes sure that they get the medical support they need. People spoken with on the day were positive about the care they get at Willow House. They made comments like ‘It’s OK here – the staff are nice’ and ‘I am very happy. Staff are good. There’s not a bad bone in their bodies. They’re wonderful’. They said staff respected their right to privacy and dignity. A relative said that were ‘very happy with the care’. They continued ‘I think it’s the best home’. They said that staff were ‘very patient’. This patience was observed on the day, and the atmosphere was very pleasant and inclusive. Staff did not rush people, and treated them as individuals. Where people are unable to manage their own, staff look after their medication on their behalf. This is stored securely so that people are kept safe from harm. The medication is audited periodically, to check that the systems are running smoothly. There were some areas brought to the attention of the registered manager which need to be improved: • In three cases, prescribed medication had not been included on the individual’s medication sheet. All medication that has been prescribed for people needs to be on their chart, so staff are clear what can be administered. Two of these were medications which would be used in an emergency. The registered manager was asked to put this right on the day. Whilst the stock in special monitored dosage packs is checked when it arrives from the pharmacy each month, and a record kept on the person’s medication sheet, an accurate stock balance for boxed medication was not counted and carried forward from the previous month. This needs to be addressed, so that it is clear how much medication there is in stock at any time, and also so that the registered manager can see easily any errors which need addressing with staff. Medication which had arrived in a special ‘dosette’ box had not been listed on the medication record. This means that staff have no record to refer to in the future about what they have administered to the person. • • Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 14 • • • Hand written entries on people’s medication records had not been countersigned and dated by a second staff member. Checking each other’s entries reduces the risk from errors occurring, and should be done. The council policy for homely remedies states that household remedies may be held in stock for the occasional treatment of residents as advised by their GP (General Practitioner). Whilst there was evidence that some homely remedies had been occasionally used, there was no formal agreement made with the GP. A decision needs to be made whether these are to be used, which should be agreed with the GPs who have patients at the home. The home was advised at the last key inspection that two staff should sign to confirm what medication has been returned to the pharmacy. The practice of only one staff member signing has continued, and in the case of the most recent return, nobody other that the person collecting the returned medication had signed the form, which was not dated. This makes it more difficult to evidence what has been returned for disposal. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. The activities for people could be developed further, but people can make choices in their daily lives about what they do, who they see, and what they would like to eat. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Of the eight people who replied in their surveys, four thought there were ‘always’ activities for them to join in. Three said this was ‘usually’ the case, and one said it was ‘sometimes’ the case. Staff who commented said there could be ‘more money to spend on trips and activities for the residents’, and the home could do better by being ‘able to have more staff to ensure residents are able to go for outings and have entertainment every, or most days’. In the Annual Quality Assurance Assessment, the registered manager told us that activities are limited due to no dedicated staffing hours, and that the home sometimes relies on ‘the goodwill of staff to add activities to their busy caring role’. Having a dedicated activities person would mean that more time could be spent planning and providing individual activities. However, the registered manager has set allocated staff hours, so would need to use staff Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 16 hours from another area of the home to provide this. This is not possible with the current allocation that she has. However, the home has tried hard over the last year to develop the range of activities available for people. One person spoken with recognised this had improved, although another said they were sometimes ‘bored’. And another said it would be nice to have more trips out. The registered manager is currently trying to develop better links with religious denominations, so that she can invite them to the home to provide people with the spiritual support that they might wish for. The activities are now advertised, and a staff member is allocated to this task each day. The activities are mainly for groups. On the day of the site visit, people thoroughly enjoyed an interactive music therapy group. The registered manager is hoping that this two year project provided by outside services will be continued, because it has been so successful. Other advertised activities included ‘a stroll in the garden’, coffee morning, reminiscing, dominoes, ice creams and sherry afternoons. And a number of people follow their own social interests. One said they enjoy ‘going to the bookies’, whilst another said that their family involvement helps to fulfil this area of their life. Another said ‘It’s alright here. I can do what I like. I’m happy as long as I can have a smoke’. We asked about how activities were provided to those people who chose to remain in their rooms. The registered manager explained that dedicated key worker time is set aside each Monday, although agreed that not all key workers are available every week. Staff spoken with said that they make the most of one to one time with these people when they assist them with their bath. And a separate bath record kept in people’s files explained how some had enjoyed this experience. People spoken with said that they can do what they want, when they want. Staff said that they try to meet people’s daily needs by being flexible in the way that they provide care. This means that one day does not have to be the same as the next. People can also have their visitors when they wish. This helps to maintain links with those who are important to them. The dining room has been refurbished since the last site visit. It was nicely decorated, with new furniture. It is a large room so there is plenty of room for people, including those who use a wheelchair. The mealtime was relaxed, and people were not rushed. There appeared to be enough staff available to assist people who needed help. The majority of people use the dining room for their meals, although we were told that, should people wish to eat in their own rooms, they could do so. The registered manager explained that she has adapted the lunch time menu, so that there is some additional choice. This meal is provided by the local hospital, and is heated on the home’s premises. The hospital is informed by Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 17 the home about people who need special diets, so that those who need for instance, a soft or diabetic diet, can be catered for. People choose in advance what they want to eat. Those spoken to on the day said that the meal was good and hot, and that generally they liked it. One person said the food was consistently good, and that ‘everyone likes it’. Of the eight people who responded in their survey, five said that they ‘always’ liked the meals, two said they ‘usually’ do, and one said that they ‘sometimes’ do. Breakfast, tea and supper is prepared by the cook at Willow House. On special occasions, she also cooks the main meal, rather than order from the hospital. People are provided with drinks between meals, and we were told that snacks are available at any time for anyone who may feel hungry. There was plenty of home baked cakes and fruit available for people to enjoy. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. People are protected by staff who will pass on concerns about them quickly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All seven people who replied in their surveys said that they knew who to speak to informally if they wanted to raise any concerns about their care, and all six who replied, said they knew how to make a formal complaint. The registered manager told us in the Annual Quality Assurance Assessment that there are ‘Have Your Say’ leaflets kept at the home which people can fill in to raise any concerns that they may have. She said these can be provided in different formats for people who may need these in, for instance larger print, or in a different language. The registered manager said she has an ‘open door’ policy. People said they know her, and see her around the home regularly. And staff said they would be confident to pass on concerns to her to be dealt with. She does not currently record in the complaints book what she described as ‘mumbles or grumbles’. It would be good practice to do so, as the staff team can learn from this feedback, which can also assist the manager in identifying trends of possible dissatisfaction, however minor. She said she intends to introduce this. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 19 The home has dealt with one complaint and one safeguarding issue since the last key inspection. The home worked with the social services safeguarding team during the time that these were being investigated. There were records kept to show what had been done during the course of the investigation, or to identify what safeguards and systems have been put into place since. Staff get training in safeguarding people. They call this ‘alerter’ training, because it tells them what to do should they witness or suspect that someone living at the home has not been treated properly. This is due for update. Staff were very clear that they must pass on any allegations straight away, and that they must not keep secrets where they believe that someone at the home may have been abused. However, they were not sure who they could speak to if they wanted to pass on information to someone other than their immediate management structure. The registered manager, who is the safeguarding champion, has agreed to refresh them about the role of the local authority safeguarding team during forthcoming supervision. This will ensure that important information is always passed on quickly to the right people in any circumstance. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. The premises are suitable to meet people’s needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The accommodation is provided on two floors. There is passenger lift access to each floor. This makes it easier for people who use a wheelchair, or who have limited mobility, to get about independently. There has been some decoration completed since the last inspection, including new carpet to the first floor corridor, and redecoration of the hallway and dining area. There is a large dining area, and a number of small sitting rooms. Two of these are for people who smoke. Possibly due to the windows and doors to these smoking rooms being open, and the fan in one being switched off, there was a smell of cigarette smoke in some of the corridors. The registered manager could not smell this, but agreed to check that the ventilation is adequate. This Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 21 will help to make all areas of the home smell fresh, and may benefit those who choose not to smoke. However, of the eight people who returned their surveys, seven of these said the home was always fresh and clean, with the remaining person stating this was usually the case. And a visitor said the home was always very clean. Off one of the sitting areas, a conservatory has been created, and leading from this a patio with seating. A sensory garden has also been created, and the registered manager told us that some people living there now help a visitor tend to the pot plants in the garden, which they enjoy doing. None of the bedrooms provide en suite accommodation. However, there are communal toilets and bathrooms placed conveniently around the home. A sample of bedrooms was looked at with the occupant’s permission. These were pleasant, and contained some personal belongings. People have their name on their door, which makes it easier for them to find their room. Some rooms have good views of the city’s bar walls. The laundry is provided in a separate area to where any food is prepared or stored. Care staff or general assistants launder people’s clothes. They explained the control systems that are in place to reduce the risk from cross infection, such as gloves and aprons, and special bags in which soiled linen is delivered to the laundry. This stops staff from having to handle such items unnecessarily. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. Staff get a range of training to help them in their work. More staff hours would help to make the home’s aim to provide personalised, individual care for people in all aspects of their daily life more achievable. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Of those who returned their surveys, six people said that staff were ‘always’ available when needed. One said this was ‘usually’ the case, and one ‘sometimes’ the case. On the day, people thought there were generally enough staff to meet their care needs. One said that when they rang their bell, the response was almost immediate, although reflected that others living there thought that there weren’t enough staff. Of the four staff members who returned their surveys, three thought there were ‘always’ sufficient of them, with the fourth stating this was ‘sometimes’ the case. We were told on the day that staff don’t always get as much time to spend one to one with people as they would like. This was partly blamed on the amount of paperwork that they are expected to complete. One staff member thought that there should be more staff available in the afternoon, when the number available drops, but when some people living at the home can become more unsettled, and need more time spent with them. Although Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 23 none of the staff said that they had to rush people when they assisted them with their care. The registered manager has an allocated number of staff hours that she can use each week. The staffing levels at a weekend are reduced, although we were told that the home is quieter during this period. She said in her Annual Quality Assurance Assessment that barriers to improvement at the home included ‘rota restrictions and staffing levels’. However, she was certain that should she need extra staff in emergency situations, this would be allowed. A recommendation was made following the last key inspection that further consideration should be given for a staff member to be responsible for the laundry, so that staff can have more time to give care and organise activities. The registered manager told us that this has not been done. However, she has informed us that the staffing levels for the home are being reviewed, and that the outcome should be known by November 2009. She was confident that staffing levels would be increased. Asking people who live at the home their views would give a good idea about where extra staff may be required, and where they felt there were sufficient. This should be considered as part of this review. The files of two recent recruits were looked at. These showed that all the necessary documentation is collected upon which to base a decision as to whether the person is suitable to work with vulnerable people. The registered manager was reminded though to check any gaps in employment history, to make sure that absences from work are not connected in any way to them being unsuitable workers. New starters complete a full induction. All four staff who returned their surveys agreed that this covered everything they needed to know about their job very well. From this, there is a rolling programme in place for staff to complete National Vocational Qualifications in Care. Some staff have completed Level 3 as well as Level 2 accreditation. This helps staff to understand what good, consistent care is, and how it should be provided. Staff complete other training to help them in their work, and felt that this was relevant training. And they agreed that the registered manager meets with them regularly, and that she supports them. Those who administer people’s medication have completed training so they know how to do so safely. Other planned training includes understanding nutrition, ‘personalisation’, which looks at how to provide ‘person centred care’, and hand washing techniques. The registered manager said that training for all staff was planned in understanding dementia, and behaviour which challenges others. She was advised to seek training opportunities for staff about understanding mental health. This would give them a broader knowledge around the conditions that some people living at the home have, and would further enhance the aims of the home, in making care very individual and person centred. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good quality outcomes in this area. The management of the home is open and inclusive. However, people’s health and safety would be assured if better precautions against the risk from fire were in place. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has held this position for a number of years. She is registered with the commission as being a fit person to carry out this role. She has completed a management qualification which underpins the work she carries out at Willow House. People say that they know her, and see her regularly. A visitor said they could go to the registered manager at any time if they had any issues. They were Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 25 pleased that she keeps in touch about any problems with their relative’s care. Staff also said that the manager was ‘approachable’, and that she ‘listened’ to them. This helps to maintain good communication amongst the staff team. The manager is supported by her locality manager, who she said visits without fail each month to carry out supervision with her. She said that the communication between the home and management has improved greatly, and that she gets good support in running the service. There have been changes made to the quality assurance systems. Managers from each service visit other homes, so that they can carry out spot audits of areas such as medication and care planning. She said this has given everyone the opportunity to learn from good practice, and see how changes can be made to benefit the running of the home. People and their families are sent questionnaires each year so they too have the opportunity to comment on how they think the home is running. The registered manager was collating the information on the day we visited, and the response showed that the majority of people were generally satisfied with the care, and how they receive it. She has noted that further work may need to be done in relation to the activities programme, and she intends to look at this further. It is also planned that visiting professionals will be surveyed, although this has not yet been introduced. Gathering these people’s views will give a further perspective on how the home is running in the best interests of those who live there. However, a health professional had recently left written feedback at the home which stated ‘I visit Willow House in a professional capacity. I find the staff work to a very high standard and are very caring, and residents always appear happy and contented’. The home looks after people’s personal allowance if this is their choice. The registered manager keeps this secure, makes a record of money handed to them, and has receipts when money has been spent on their behalf. Nobody manages their own finances. Although the registered manager said that they would be supported to do so if this was their choice. People have facilities in their rooms to keep money and valuables safely locked away. The information provided by the manager, and that looked at during the site visit, confirmed that the home is kept maintained, so it is a safe place for people to live in. The fire officer has not provided a report recently, but we were told that recommendations made within the fire safety risk assessment were planned to be addressed. The Environmental Health Officer has inspected the kitchen since the last site visit. Their overall judgement was that the kitchen was clean and well managed. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 26 In addition, staff get a range of training, which is updated periodically, so they know how to work in a safe way. This includes training in moving and handling, fire safety and infection control. Further training is planned in food hygiene, and the registered manager said there are enough staff with a first aid qualification to make sure that there is always a qualified person on duty to deal with any emergencies which require first aid attention. However, the following issues which need attention were discussed with the manager at the time of this site visit: • A small fire in a litter bin in the smoke room occurred on 1 August 2009. Staff took the correct action, and called the fire brigade, who recommended that each smoke room should be provided with a sand bin, to reduce the risk from fire. This recommendation had not been actioned at the time of our visit, on 8 September 2009. The registered manager said she would see that this recommendation was met. At the last key inspection a year ago, a requirement was made that fire doors must not be held open by unauthorised means. Again, at this site visit, a bedroom fire door, fitted with a self closer, was wedged open. This increases the risk to the person occupying the room from the spread of fire, as the door would not shut should the fire alarm go off. The door wedge was removed immediately by the registered manager, who has given her assurance that it will not be used again, and that people, staff and visitors will be reminded of the increased risk to people, which means this practice must cease. • Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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. 1 Standard OP7 Regulation 13 Requirement People’s care plans must clearly indicate identified risk to them, and how this risk is to be managed and monitored in order to maintain their health, safety and welfare. All medication prescribed by the person’s doctor must be included on their medication chart so staff know what the person is prescribed, and so that there is a clear record of what has been administered to the person. Action must be taken quickly, when recommendations are made by the fire officer to reduce the spread from fire, as following their advice will reduce the risk to those living at the home. Fire doors must not be held open by inappropriate means. To make sure that people are protected from harm in the event of a fire. Timescale of 25/10/08 not met Timescale for action 31/10/09 2 OP9 13 08/09/09 3 OP38 13 08/09/09 4 OP38 12(1) 08/09/09 Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 29 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 OP9 Good Practice Recommendations The balance recorded on people’s medication records should match with that which is held in stock for the person. This will keep the records correct, and will allow the staff member auditing the medication to check that the medication is being given as prescribed, and in the right quantity. Hand written entries on people’s medication records should be checked by another member of staff, countersigned and dated. This is to reduce the risk from error. The council policy should be followed, in that the use of homely remedies should be agreed with the doctors who have patients living at the home. It is good practice for two staff at the home to sign and date to witness medication has been returned to the pharmacy for disposal, so there is a clear record of what has been returned on behalf of the person to whom the medication belongs. So that people’s social opportunities can be further enhanced, the review of the staffing hours for the service should include consideration of additional dedicated activities hours, so that the opportunity for individual activities can be increased. ‘Concerns and grumbles’ received by the home should be recorded, and the action taken to resolve these. This would assist the manager in identifying trends of possible dissatisfaction, however minor. The ventilation from the smoke rooms should be checked to make sure that it is working effectively. This will help to keep non smoking areas free from the smell of tobacco smoke. The planned review of staffing levels at the home should consider: 2 OP12 3 OP16 4 OP19 5 OP27 Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 30 • • • • the views of people living there the views of staff fluctuations in dependency non care tasks which care staff currently undertake 6 OP29 7 OP30 This will assist in the right number of staff being available at the right time, and in the right capacity. During staff recruitment, gaps in employment should always be explored, to make sure that unexplained absences from work are not connected in any way to the person being an unsuitable worker. Training opportunities for staff about understanding mental health should be pursued. This would give them a broader knowledge around the conditions that some people living at the home have, and would further enhance the aims of the home, in making care very individual and person centred. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 32 Willow House - City of York Council DS0000034914.V377219.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!