Care Home: Willow Lodge

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What the care home does well Care plans are of a good standard and were found to be comprehensive covering health and personal care needs. The opportunities for residents to engage in activities and stimulation is good with a daily activity programme from Monday to Friday. The home has its own activities co ordinator employed for 24 hours a week. A staff member was observed to be particularly skilful in helping residents who have dementia. What has improved since the last inspection? Care plans have been revised and improved and include guidance for staff in dealing with needs such as pressure care prevention and treatment. Staff also receive training in pressure care treatment. The home now employs an activities co ordinator who organises a range of activities including outings and arts and crafts. The numbers of staff has increased. Staff supervision has been improved and now takes place on a regular basis. Improvements have been made to the environment. Five bedrooms have been refurbished since the last key inspection. What the care home could do better: Random inspections carried out since the last key inspection have shown areas where there is a need for improvement, notably maintaining a safe environment. Whilst these have been addressed, the service needs to demonstrate that these improvements can be sustained. Whilst there is a a programme of refurbishment of bedrooms a number of rooms need to recarpetted and there are signs of wear and tear in bedrooms. Some shortcomings in recording and the availability of records were noted. Key inspection report Care homes for older people Name: Address: Willow Lodge 11-15 Stein Road Emsworth Hampshire PO10 8LB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ian Craig     Date: 0 4 0 8 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Willow Lodge 11-15 Stein Road Emsworth Hampshire PO10 8LB 01243375382 01329836287 andrew.geach@willow-lodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Andrew Robert Geach,Mr Stephen Richard Geach Name of registered manager (if applicable) Miss Karey Abbott Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Willow Lodge is registered to support and accommodate up to 26 older people any one of whom could have a diagnosis of dementia. The home is in the residential area of Southbourne, close to Emsworth. There are 14 Care Homes for Older People Page 4 of 25 Over 65 0 26 26 0 0 5 0 5 2 0 1 0 Brief description of the care home single bedrooms and six double rooms, over three floors. The majority of the rooms have en-suite facilities, although most of en-suite baths are not currently in use. There is one communal bathroom with an adapted bath on the second floor as well as a shower room. The ground floor has a walk-in shower room. The home has a large open plan dining room / lounge which opens out onto a large patio area and secure rear garden. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and lasted for four hours and thirty minutes. Records, documents and policies and procedures were looked at, including residents care records. Discussions took place with the manager and one of the proprietors Mr Andrew Geach. Six staff were spoken to and two residents were asked about their views of the home. A key inspection was carried out on 17 November 2009 when the service was rated as poor. Two further follow up inspections took place on 18 February 2010 and 5 May 2010. A warning letter was issued following the visit of 5 May 2010 due to failures to fully implement a requirement regarding health and safety, and for staff working excessive hours. These have now been addressed. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are able to make an informed choice about whether or not to move into the home and individual assessments help ensure that the home accommodates only those whose needs it can meet. Evidence: The home has a brochure and a Statement of Purpose. They give details about the service provided by the home, such as the admission procedure, the complaints procedure, the staffing and management of the home and the contract. Copies are available for those considering a move into the home. The process of assessing the needs of those referred for admission to the home was looked at for two people recently accommodated at Willow Lodge. Records show that the home carried out an assessment of need prior to the person being admitted. The assessment covered personal and health care needs as well as any possible risks to the individual. Care records also contain relevant information from other agencies Care Homes for Older People Page 9 of 25 Evidence: such as hospital discharge details and assessments by referring social services departments. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets the health and personal care needs of the residents. Residents are treated with dignity and their privacy is promoted. Evidence: Care records were looked at for four residents. These were found to be comprehensive covering health and personal care needs including the following: personal history, communication, important relationships and social contacts, general health, physical activities, memory, interests/activities, spiritual/religious/cultural needs, end of life agreement, routines and preferences, nutritional preferences, medication, washing, dressing/choosing clothing, continence care/toileting, hair care, bath/shower needs, shaving, optical/audio, foot care, oral hygiene and a separate care plan for the night time. Specific assessments are carried out and recorded with associated care plans for needs such as the prevention of pressure sores, wound monitoring and treatment, nutrition and moving and transfer needs. Care records include analysis of any injuries Care Homes for Older People Page 11 of 25 Evidence: such as skin tears as well as liaison with relevant health care professionals such as the district nursing team and the residents General Practitioner. Staff receive training in the management of pressure care twice a year. Care plans show that needs regarding nail care were identified at the time of admission and arrangements were made for chiropody services. Health care needs such as weight, pulse and blood pressure are monitored. Records show that assessments are carried out where risk is identified such as nutrition, mental health and behaviour. The home uses a risk assessment pro forma for identifying the hazards and taking action to minimise the risk. This assessment uses a score system. Completed assessments include guidance for staff about how to minimise risks. Care records have a photograph of each person. The preferred form of address that the person likes to be called is recorded. Individual routines and preferences are recorded such as times for getting up. Screens were seen to be used to give privacy for those being assisted with lifting hoists in communal areas. Privacy screens are available in shared bedrooms. Staff report that residents are treated with respect. One person told us that, Staff involve residents with everything. Staff have patience in dealing with the residents. Staff were observed working with residents in communal areas and noted to be skilled in interacting with those with dementia. The homes medicines procedures were looked at. Staff record a signature each time they administer medication to a resident. Checks on the stocks of medication show that it was administered as prescribed. Controlled drugs are stored in an approved cupboard. Records show that two staff are involved in the procedure: both recording the amount given and the amount remaining. A check on the stock of a controlled drug matched the balance recorded by staff. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a range of well organised activities. A choice of nutritious meals are provided. Evidence: The home employs a part time activities co ordinator for 24 hours a week for the purpose of organising and providing activities. An activities programme was displayed on a notice board in the lounge, which included baking cakes, quizzes, gentle exercise, companionship time, hand massage and beauty treatements. The activities programme has scheduled events Monday to Friday. Photograph displays show residents taking part in various activities. There was also a notice of a forthcoming garden party. Records are maintained of each persons participation in activities. They show individuals are involved in regular activities such as listening to music, playing a musical instrument, gardening and feeding the homes guinea pigs. A monthly newsletter with information about the homes activities was available in the lounge. The activities co ordinator described how a number of residents are currently involved in painting a piece of art work on a large canvas. There was a display of items designed to stimulate residents memories such as books about World War Two and the 1950s. Twelve residents were observed taking part in activities in the lounge. Care Homes for Older People Page 13 of 25 Evidence: The provision of food was looked at. Midday meals are provided by an outside caterer. The homes chef described this as being positive and that the caterers provide a good choice of food from two hot dishes and a cold dish each lunch time. It was also reported that the caterers can provide specialist food when residents dietary needs change. The chef said that adequate amounts of fresh fruit and vegetables are provided. The midday meal looked appetising and was served to residents at tables set with table cloths and napkins. Residents said that they liked the meals. Where needed individual residents intake of fluids and food are monitored and recorded. The chef said that she has attended a dieticians course and that kitchen staff have completed food hygiene training. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an effective complaints procedure. The home has taken steps to help ensure the protection of residents. Evidence: The home has a complaints procedure which is contained in the Statement of Purpose. The home maintains a log book of any complaints: two are recorded for 2010. Details of the complaint are logged plus action taken by the home to investigate and address any concerns. These details include a meeting with a residents relative, plus a letter to the complainant of the findings of the complaint investigation and the action being taken. The service has a copy of the local authority safeguarding vulnerable adults procedure. Since the last key inspection there has been four investigations regarding safeguarding matters. The service has worked with the relevant agencies to investigate and address any concerns. These have now been resolved. The homes manager has made a recent safeguarding referral and is awaiting a response from social services. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to make improvements to the bedrooms and communal areas, although the programme to refurbish bedrooms needs to be completed to ensure the environment meets an acceptable standard. The home is clean. Evidence: Each of the residents bedrooms was seen. There is a programme to refurbish each bedroom at a rate of one bedroom a month. It was noted that there are signs of wear and tear in those rooms not yet refurbished and that carpets were stained in two rooms. A requirement has not been made for this as there are refurbishment plans in place. The service needs to ensure that the refurbishment programme is completed. This will be checked at future inspections. The home employs its own maintenance person for approximately 40 hours a week. Bedrooms contain items of personal belongings such as pictures, ornaments, books and magazines. Screens are provided for privacy in the double bedrooms. Lockable storage is provided in rooms so that residents can secure their valuables. Care Homes for Older People Page 16 of 25 Evidence: There is a lounge- dining room on the ground floor. Residents were observed using this area for activities, socialising and eating meals. The home has ramped access to a garden patio, which has tables and chairs. The home was found to be clean and free from any offensive odours. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient trained and skilled staff to meet residents needs. Staff recruitment procedures protect residents. Evidence: The staff rota was examined for the week commencing 31 July 2010. This showed the provision of at least four care staff from 8am to 2 pm each day and at least three care staff from 2pm to 8pm. At the time of the visit the following staff were noted to be on duty at 1230pm: an activities coordinator, the manager, the deputy manager, four care staff, the chef and a maintenance person. Two care staff stated that the home provides enough staff to meet the needs of the residents. The Commission received information since the last key inspection that a staff member had worked a 24 hour shift. This was was confirmed by the service, but, was due to exceptional circumstances. At an unannounced inspection on 5 May 2010 it was noted that two staff were regularly working in excess of sixty hours a week. A requirement was raised that staff must not work excessive hours. At this inspection it was found that this has been addressed. Care Homes for Older People Page 18 of 25 Evidence: Staff recruitment procedures were looked at for three people who have recently started work at the home. Each person completes an application form and is interviewed for the position. Records show that two written references are obtained before the person starts work and that one of these is from the most recent previous employer. A criminal record bureau (CRB) check and a Independent Safeguarding Authority check are obtained. Training records show that newly appointed staff have an induction based on nationally recognised standards to prepare them for the job. This was also confirmed by staff we spoke to on the day of the visit. The induction includes training in moving and handling, abuse awareness and medication procedures. Seven of the fourteen care staff hold National Vocational Qualification (NVQ) level 2 in care and one person has NVQ level 3 in care. A further three staff are due to commence NVQ level 3 training. Staff confirmed that a variety of training courses are provided. Residents said that the staff are helpful and kind. Staff were observed to treat residents with respect. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there have been improvements to the way the home is managed recent inspections show that this needs to be sustained. Some shortcomings in recording were noted. Evidence: Since the last key inspection the homes manager has registered with the Commission. She has recently completed a five day course in management skills and is due to start a course called, Leadership in Management and the National Vocational Qualification level 4 in care. Staff spoken to on the day of the visit described the homes management structure as supportive and approachable. Staff commented that they work as a team and that management support is always available. The home asks residents and health and social professionals for their views on the Care Homes for Older People Page 20 of 25 Evidence: service provided. The results of the surveys are summarised and compiled into pictorial diagrams of response and are displayed on a notice in the hall. Residents meetings are also held each month so that the views of the people who live in the home can be expressed. A record of the last residents meeting was seen. The manager confirmed that she acts on the views expressed by residents. A record of a residents meeting showed that residents wanted more activities. The manager told us this was instrumental in appointing an activities co ordinator. Monthly audit visits to the home and reports are completed by one of the proprietors or by a representative of the proprietors. This is a requirement under Regulation 26 of the Care Homes Regulations 2001. Copies of these reports must be available in the home, but were only available for four of the nine months since the last key inspection. The service sent copies of the remaining reports to the inspector the day after the inspection. The reports show that different aspects of the homes service are auditted and monitored with corresponding plans of action to address any issues. This includes an audit against the national minimum standards and the Care Homes Regulations 2001 for the following: observation and assesment of suitable staffing levels, care planning and delivery of health and personal care, the environment, staff training and supervision, staff recruitment and any improvements that are needed. A monthly report had looked at how a complaint had been been managed and how the service responded. Another report had assessed staff awareness of adult safeguarding and identified that additional training was needed, which has been acted on. The home looks after the money and valuables for some residents. The records and amounts held were checked for three people. Any amount deposited or withdrawn is recorded along with a running balance. The amounts being held tallied with the the records of the amount being held. For one person the record was £1 less than the amount held and was identified by the manager as stemming from an error in a previous record. Staff receive regular supervision. This was evidenced from a supervision matrix record, individual supervision records, from staff themselves, and from discussions with the manager. Regular staff meetings are held as well as weekly senior staff meetings. The manager states she meets with staff on a daily basis to discuss matters about the home and residents. The last inspection visit to the home was a random inspection on 5 May 2010. A warning letter was issued to the service regarding failures to fully implement a requirement regarding health and safety in the home. Following the visit, the service confirmed in writing that the matters were being addressed. This was also confirmed Care Homes for Older People Page 21 of 25 Evidence: at this visit. As required by the previous report, the service has completed a series of risk assessments for the environment. A number of changes have been made to the environment to improve its health and safety, such as the installation of additional handrails on the stairs. Staff have completed training in first aid, infection control and moving and handling since the last key inspection. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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