Care Home: Willowbank Nursing Home

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What the care home does well The information about Willowbank was clear and detailed and made available to new and existing residents and their relatives; this would help them to decide whether the home was the right place for them to stay. New residents were only admitted to the home following a detailed assessment of their needs; this would help to determine whether they could be looked after properly at Willowbank. Most of the staff had a recognised qualification in care which would help them to look after people properly. Residents said they were happy with the care and support they received. One visitor said they were kept up to date with any changes to their relatives health and wellbeing and that staff responded to residents individual needs; one resident said `I`m well looked after`. One visitor wrote to us and said `we are very satisfied with the care`. Staff responded in a friendly and respectful manner to residents and visitors. It was clear that staff had developed good relationships with residents and their relatives. Records showed that a range of daily activities were taking place and that they were tailored to meet individual and diverse needs. Comments from residents included `there are good activities`, `there is something to keep everyone busy` and `there are things going on`. Some residents said they were able to make decisions and could do what they wanted and that staff listened to them and acted on what they said whilst other residents relied on staff to make the right decisions for them; one resident said `I can go where I want`. Staff said the flexibility of routines and choices had improved. The menu offered a choice of healthy and nutritious meals with alternatives provided. Residents said `the meals are `the meals are nice` and `I enjoyed my lunch`. One staff said `the home provides good food`. The complaints procedure was clear and easy to understand and made available to residents and their relatives; this would give them the information if they needed to raise any concerns or complaints. The safeguarding procedures (formerly adult abuse procedures) gave safe guidance for staff and most staff had received training to help them to recognise and respond to abuse and neglect; this would help them to keep residents safe. Staff were provided in sufficient numbers to meet the needs of the current residents. Residents made positive comments about the staff team; comments included `staff are nice`, `staff are pleasant and polite` and `they are very helpful`. People were consulted and their views and opinions were used to improve the service; this involved them in the day to day running of the home. The home was safe for residents, visitors and staff. Residents bedrooms were bright and comfortable; some residents had brought in personal items to enhance the homely feel. One resident said `my room is very nice` and another said `I have everything I need here`. What has improved since the last inspection? During a tour of the home and the grounds it was clear that further work had been completed to improve all areas; this provided residents with a safe, pleasant and well maintained place to live. Management had considered good practice guidance from the dementia and Alzheimer`s societies to ensure the improvements were appropriate to meet the needs of the current residents. The content of and the review of the care plans had improved since the last key inspection visit although further improvements could be made to ensure the records reflected the care that was being given to meet resident`s needs. The way that medicines were managed had improved; this would prevent medicines from being misused and ensure residents received their medicines as prescribed. A safe recruitment process had been followed and would help to protect residents from unsuitable people. Communication between staff had improved and would help to improve residents care and the day to day running of the home. The manager had been registered with the Care Quality Commission and would provide day to management of the home. What the care home could do better: The training records still did not fully reflect the current skills and competencies of staff; however the manager was aware of the gaps in the provision of training and the records were being reviewed. The detail in the care plans did not always reflect the care that was being given or clearly record resident`s routines and preferences. Also it was not always clear whether residents and their relatives had been involved in the development and review of their care; people should be involved in decisions about their care to ensure they receive the care they both need and want. Some areas of the home were in need of attention to ensure residents were provided with a safe and pleasant place to live. Systems to monitor whether staff were following procedures needed to be developed. Key inspection report Care homes for older people Name: Address: Willowbank Nursing Home Willowbank Nursing Home Pasturegate Burnley Lancashire BB11 4DE     The quality rating for this care home is:   two star good 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: Marie Matthews     Date: 1 8 0 5 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 30 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 30 Information about the care home Name of care home: Address: Willowbank Nursing Home Willowbank Nursing Home Pasturegate Burnley Lancashire BB11 4DE 01282455426 01282455345 willowbank@sagecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sage Care Homes (Willowbank) Limited Name of registered manager (if applicable) Mrs Diane Mary Ireland Type of registration: Number of places registered: care home 53 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Dementia - Code DE Mental disorder, excluding learning disability or dementia - Code MD The maximum number of people who can be accommodated is: 53 Date of last inspection Brief description of the care home Willowbank is registered to provide both nursing and personal care for fifty-three residents with either a dementia or mental health problem. The home is set in a quiet, pleasant residential area approximately a mile from Burnley town centre with shops, a post office, public houses and a convenient bus route Care Homes for Older People Page 4 of 30 1 4 0 9 2 0 0 9 53 53 Over 65 0 0 Brief description of the care home nearby. The home is a detached two storey building with a purpose built extension set in 1.5 acres of garden, with attractive lawns, flower beds and patio areas. The majority of bedrooms are single and some have en suite facilities; others are located near to toilet facilities. There are a number of pleasant, comfortable lounge and dining rooms. Information about the services that the home offers is provided in the form of a service user guide and is available to existing and prospective residents and their relatives. A summary of the most recent inspection report is available within the service user guide. On the day of the key inspection the weekly fees ranged from £438.00 to £595.00. Items not included in the fee include newspapers, hairdressing and personal toiletries. Care Homes for Older People Page 5 of 30 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: two star good 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 key unannounced inspection, including a visit to the home, took place on 18th May 2010. The last inspection on this service was completed on 14th September 2009. The inspection process included looking at records, a tour of the home, discussions with the registered manager and deputy manager and three residents. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Information was also included from a written communication with one visitor and surveys completed by one visitor, four residents and three staff. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? During a tour of the home and the grounds it was clear that further work had been completed to improve all areas; this provided residents with a safe, pleasant and well maintained place to live. Management had considered good practice guidance from the dementia and Alzheimers societies to ensure the improvements were appropriate to meet the needs of the current residents. The content of and the review of the care plans had improved since the last key Care Homes for Older People Page 7 of 30 inspection visit although further improvements could be made to ensure the records reflected the care that was being given to meet residents needs. The way that medicines were managed had improved; this would prevent medicines from being misused and ensure residents received their medicines as prescribed. A safe recruitment process had been followed and would help to protect residents from unsuitable people. Communication between staff had improved and would help to improve residents care and the day to day running of the home. The manager had been registered with the Care Quality Commission and would provide day to management of the home. 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 8 of 30 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 9 of 30 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. People were provided with information about the home that helped them to decide whether their needs would be met. Residents needs were assessed prior to admission and staff had the skills and experience to look after people properly. Evidence: People were given clear information about services offered at Willowbank to help them to decide whether it was the right place for them to stay; the manager advised that the information could be made available in other formats and there was also a web site where people could see the facilities on offer at Willowbank. Three residents files were looked at in detail. Each resident had been given a copy of a contract or statement of terms and conditions with the home; this ensured they were aware of their rights and responsibilities whilst living at Willowbank. New residents were only admitted to the home following a detailed assessment of Care Homes for Older People Page 10 of 30 Evidence: their needs; this would help to determine whether they could be looked after properly. The assessments were undertaken by an experienced member of staff and information was gathered from a range of sources including the resident and their relatives; this would ensure all aspects of their needs were considered. People were also sent written reassurance that their needs could be met. Records showed that staff were provided with the training they needed to maintain their skills and competencies; staff confirmed that they received relevant training. Prospective residents and their families would be invited to visit the home to view the facilities and to meet residents and staff before deciding to live there. One resident said they were very happy with the home and had been able to visit a number of times before deciding to move there. Care Homes for Older People Page 11 of 30 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 content of the plans had improved since the last key inspection visit although further improvements could be made to ensure the records reflected the care that was being given to meet residents needs. The management of medicines had improved and peoples privacy and dignity were respected. Evidence: Three care plans were looked at in detail. The content of the plans had improved since the last key inspection visit although further improvements could be made to ensure the records reflected the care that was being given to meet residents needs. The care plans had been reviewed each month but it was not always clear whether residents and their relatives had been involved in the development and review of their care; people should be involved in decisions about their care to ensure they receive the care they both need and want. Residents said they were happy with the care and support they received. One visitor said they were kept up to date with any changes to their relatives health and wellCare Homes for Older People Page 12 of 30 Evidence: being and that staff responded to residents individual needs; one resident said Im well looked after. One visitor wrote to us and said we are very satisfied with the care and management and staff are continually looking for ways in which residents care can be improved upon. Staff had received training to help them to understand rights, privacy, respect and dignity. Staff were observed responding to residents and visitors to the home in a friendly and respectful manner. Residents were dressed appropriately and able to choose their own clothing or clothing was chosen by staff with their dignity and best interests in mind. There was not always enough information about residents personal likes, dislikes and preferences which made it difficult to determine how staff would meet their needs. There was evidence that residents health needs were monitored and appropriate advice had been sought if there were any concerns. There were registered nurses on duty at all times and care staff had received training in health care matters; this would help them to recognise any changes to health and to respond appropriately. Staff were reminded that any short term health problems such as chest infections should be supported by a plan of care; this would ensure any changes to health were responded to appropriately. Assessments of residents nutritional status were in place on only one of the care plans; the information would help to identify whether residents were at risk of malnutrition. Weights were recorded each month although one resident had clearly lost weight yet it was not clear from the records that appropriate action had been taken. Assessments to determine whether residents were at risk of falling were in place and any action to be taken to reduce or remove the risks were recorded. The use of bed rails was not always supported by a risk assessment and had not been discussed with the resident or their relatives. There were assessments in place to determine whether residents were at risk of developing pressure sores and appropriate care and equipment had been provided to help reduce the risks; the plans clearly recorded the action that staff would need to take to ensure residents received the care and support they needed. The care plans included some useful information to help staff to communicate with residents and to respond to any difficult behaviours; this would help to keep staff and Care Homes for Older People Page 13 of 30 Evidence: residents safe. Decisions regarding any limitations to choice were clearly recorded and agreed and discussed with the resident or their relative. Records showed that professional advice had been sought regarding the promotion of continence and necessary aids were provided. There were still no systems in place to monitor the content of the care plans although the manager advised that a system would soon be introduced. Monitoring systems would help to identify whether residents needs were being met and any gaps in the record keeping (see standard 33). The medication policies and procedures provided staff with safe guidance. Current residents were not able to safely manage their own medicines, however there should be evidence to support that they have given their permission for staff to take responsibility for this. Medicines were stored appropriately although it was noted that the security of medicines for disposal was compromised as all staff had access to the treatment room; immediate action was taken to address this issue. Also an oxygen cylinder was free standing whilst in use in a residents room which could place people at risk of injury; the manager advised that action had been taken to address this issue. Records showed that medicines had generally been managed safely. There were clear protocols to support staff with the administration of PRN or as needed medicines. It was noted that prescribed creams were still being administered by care staff and signed for by the nurse in charge; further advice was given to the care manager and registered manager to ensure residents received the treatment they had been prescribed. The community pharmacist visited the home at regular intervals to monitor whether medicines were being managed safely although the home should consider developing their own systems to monitor and improve practice (see standard 33). Care Homes for Older People Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents diverse social needs and expectations were met and they were able to make choices and decisions regarding their daily lives. Residents were provided with a healthy, varied and nutritious diet that met their dietary needs and expectations Evidence: An activity coordinator was employed to arrange activities, excursions and entertainments for the residents. Records showed that a range of daily activities were taking place and that they were tailored to meet individual and diverse needs. Some of the care plans did not include much information to indicate residents likes, dislikes or routines although this was being collated; this information would help staff to provide suitable activities for each resident. Records, discussion with residents and staff and observation showed that residents were involved in a range of suitable activities, entertainments and excursions that met their needs and expectations. Activities were arranged for residents to participate as a group or with one to one support. Comments from residents included there are good activities, there is something to keep everyone busy and there are things going on. Care Homes for Older People Page 15 of 30 Evidence: There were a range of themed lounges where residents could enjoy watching television, listening to music or just sitting quietly. On the day of the visit some residents were enjoying the view of the grounds from the quiet lounge, enjoying the musical entertainment in another lounge, sitting in the sensory area where they could listen to soothing music, reading newspapers, magazines and books, walking around the grounds and hanging the laundry on the washing line. Residents were able to access any area of the home although some areas were still key coded for safety reasons. Some residents said they were able to make decisions and could do what they wanted and that staff listened to them and acted on what they said whilst other residents relied on staff to make the right decisions for them; one resident said I can go where I want. Staff said the flexibility of routines and choices had improved. Residents and their visitors were invited to weekly chit chat sessions where they discussed current events and were consulted about how the home was run. Visitors were made to feel welcome and residents said they could see their visitors in any area of the home and various comfortable communal or quiet areas were provided. Links with the local community were being developed and volunteers were involved in providing social assistance and support to residents where needed. The menu offered a choice of healthy and nutritious meals with alternatives provided; records showed that all residents were offered a healthy and nutritious diet. Staff were aware of residents dietary preferences and some information relating to this was included in the care plans; this would help to ensure residents dietary needs and preferences were met. Residents said they enjoyed the lunchtime meal; comments included the meals ar the meals are nice and I enjoyed my lunch. One staff said the home provides good food. Staff were observed giving patient support and encouragement where needed. Residents had a choice of bright and pleasant dining rooms to dine in. There were small kitchenette areas available for visitors to make a cup of tea and for more able residents to make snacks and drinks. Care Homes for Older People Page 16 of 30 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. People were protected by the organisations procedures and staff knowledge. Evidence: The complaints procedure was clear and easy to understand and made available to residents and their relatives; this would give them the information if they needed to raise any concerns or complaints. Residents were aware of who to speak to if they were unhappy and staff said they knew how to respond to any concerns or complaints; this would ensure peoples concerns would be dealt with properly. Four residents said staff treated them well and said the manager visited them to ask if they were happy with the service. One visitor said they had raised concerns and that the home had responded appropriately. Records had been maintained and showed that any concerns or complaints had been responded to properly; in the past twelve months there had been eight complaints, none of them had been upheld. Concerns and complaints were monitored each month and the information had been used to improve the service. The safeguarding policies and procedures (formerly adult abuse procedures) gave safe guidance for staff although it was noted that the full policy was missing from the procedure file and should be replaced to ensure staff had access to detailed information. It was again recommended that the contact information of local agencies Care Homes for Older People Page 17 of 30 Evidence: who would be involved in any safeguarding incident should be included in the procedure; this would ensure staff had the correct information to refer incidents promptly. Staff had received training that would help them to recognise and respond to any abuse and neglect and further training was planned. It was recommended that a senior member of staff attended the local authority safeguarding update training; this would give them the skills and knowledge to update staff with local policies. In the past twelve months there had been a number of safeguarding alerts made to the appropriate agencies; this showed that managers and staff were aware of and had followed safe procedures to keep residents safe. Thorough recruitment checks were in place which would help to protect residents from being cared for by unsuitable people. There were procedures to support staff with reporting any poor practice within the home which would help to identify any abuse or neglect; it was recommended that the contact numbers of local agencies should be included. There were procedures to support staff with dealing with aggression and the use of restraint measures. The use of bed rails should always be assessed, discussed and agreed with the resident or their relative and kept under review; this would help to determine whether this form of restraint was appropriate (see standard 8). There were procedures to support staff with dealing with residents finances and responding appropriately to verbal or physical aggression; the procedures would help staff to protect residents best interests and to keep themselves and others safe. Some staff had received training to support them with dealing with verbal and physical aggression; this would help them to respond properly and would keep everyone safe from harm. Staff had access to procedures that would support them with the Deprivation of Liberty Safeguards and Mental Capacity Act; this would make staff aware of their responsibilities when supporting residents with their decisions and choices. The manager advised that training in this area was being sourced. Care Homes for Older People Page 18 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, comfortable, clean and well maintained environment with evidence of ongoing improvement. Evidence: During a tour of the home and the grounds it was clear that much work had been done to improve all areas; this provided residents with a safe, pleasant and well maintained place to live. Major changes to the building were complete but ongoing improvements and maintenance work was still ongoing. The home was safe and had complied with recommendations from the fire safety officer and environmental health officer. Any areas in need of attention were communicated to the handyman. The handymen were responsible for minor repairs and improvements; records showed that repairs were done promptly. During a tour of the home areas identified in need of attention included the main lounge/dining area carpet was in need of replacement or cleaning, radiator covers and the walls in the kitchen conservatory were in need of attention, numerous doorways and doors were badly damaged and some could place residents at risk of injury (major damage was attended to on the day of the inspection), curtains in lounges were falling off the rails and hot pipework was unprotected in some rooms and could place residents at risk from hot temperatures (the manager contacted the plumber for Care Homes for Older People Page 19 of 30 Evidence: assistance with this matter following the inspection). The fire exit from the kitchen conservatory area was blocked by a table to prevent residents leaving the home; it was recommended that a more suitable gate was considered to allow residents some wander space without placing them at risk. Management had considered good practice guidance from the dementia and Alzheimers societies to ensure the improvements were appropriate to meet the needs of the current residents. Resident had been consulted, where possible, about the changes and colour schemes; this showed they were involved in decisions about the day to day running of the home. There were a variety of communal rooms for residents and their visitors to enjoy including small kitchenettes where they could make a drink. Furnishings were comfortable and suitable for current residents. The extensive grounds were safe, accessible and well maintained. Residents and their visitors were able to walk or sit in the grounds and enjoy the attractive gardens or the local wildlife. There was a separate secure patio area at the rear of the building with raised flower beds and washing lines where residents could hang their clothes. Toilets and bathrooms were suitably equipped to meet residents needs and located near to communal and bedroom areas; some bedrooms benefited from en suite facilities and some with en suite showers. There were aids and adaptations to meet the diverse needs of the residents and residents could access all areas of the home by means of ramps or a passenger lift. Key pads were in place on some doors with residents safety in mind; some residents were aware of the codes allowing them free access. There were designated storage areas for aids and equipment including wheelchairs and all rooms were fitted with an accessible alarm facility to enable residents to call for assistance from staff; non provision of call leads had been risk assessed and recorded in the care plan. Residents bedrooms were bright and comfortable and some residents had brought in personal items to enhance the homely feel. One resident said my room is very nice and another said I have everything I need here. Residents were provided with a lockable storage space to store personal items and bedroom doors were fitted with suitable locks; this would ensure residents rights to privacy. The home was clean and free from offensive odours; residents said the home was fresh and clean. The laundry was situated away from communal and bedroom areas Care Homes for Older People Page 20 of 30 Evidence: and equipped with the appropriate equipment to ensure residents clothing could be cared for properly; the manager advised that a new dryer had been requested to improve efficiency as there had been some concerns raised by visitors regarding the care of residents clothing. Care Homes for Older People Page 21 of 30 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. Staff were suitable, competent and provided in sufficient numbers to meet the needs of the current residents. Evidence: Staff rotas were clear and reflected a good skill and gender mix of staff to meet residents needs; any shortfalls had usually been covered by existing staff which would ensure residents were looked after by staff who knew them. Three staff said there were usually enough staff although one commented that there should be more staff and less sickness. The recent introduction of sickness and absence monitoring would help to improve staffing levels and maintain staff morale. One resident said there are enough staff to help. Residents made positive comments about the staff team; comments included staff are nice, staff are pleasant and polite and they are very helpful. Most of the staff had achieved a recognised qualification in care and other staff were working towards one; this would give them the skills and knowledge to meet residents needs and showed that the organisation were committed to improving the standards of care by provision of training. Three staff files were looked at in detail and showed that a safe recruitment process Care Homes for Older People Page 22 of 30 Evidence: had been followed; this would help to ensure that residents were protected from unsuitable people. It was discussed that a checklist of records was introduced to help to improve the process. Staff had been given a contract of employment and a job description; these records would make staff aware of their rights and responsibilities whilst employed at Willowbank. A record of the interview was in place and would help to show that the selection process was fair. There were records to support that all staff were provided with ongoing training to give them the skills and knowledge to help them to meet residents needs and to keep people safe. Staff said they received the relevant training they needed to meet residents needs. The training matrix and individual training plans were still not up to date, however the manager was aware of the gaps in the provision of training and the training plan was being reviewed. New staff received an introduction to the home and were initially supported by staff until they had the skills and confidence to work safely and independently. Staff met with their manager on a regular basis; this would help to monitor their care practices and to identify any need for additional training and support. Regular staff meetings were held to keep them up to date and to give them the opportunity to be more involved in decisions about improvements and developments. Staff comments indicated that communication had improved; this would help to ensure residents needs were met. See standard 4 and standard 37 for any requirements and recommendations made under the above staffing outcomes. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe and peoples views and opinions were used to improve the service. Evidence: The registered manager is Mrs Diane Ireland; she has the required qualifications and experience to run the home, is supported by a senior manager and her practice is monitored at regular intervals. Mrs Ireland is able to meet and discuss any issues with other registered managers within the organisation and is kept up to date with changes to legislation and the organisations plans for the future. Regular meetings had been held with residents and their relatives although it was recommended that these should be minuted; it was clear that people were involved in the day to day running of the home. Peoples views had been sought through an annual survey; the results had been made Care Homes for Older People Page 24 of 30 Evidence: available and had been used to improve the service. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a reasonable picture of what had improved over the past twelve months and where further improvements were needed. The home had taken action to respond to the issues raised at the last key inspection; this showed that they were able to work with us to improve the service. The organisation was due to introduce systems to monitor all aspects of staff practice and whether residents needs were being met; audits would help to identify any shortfalls in record keeping and care practices and could be used to improve the service. The home had achieved the Investors In People award; this is an quality assurance award accredited by an outside body and demonstrates a commitment to developing staff and improving the management of the home. Policies and procedures were being reviewed and updated to provide staff with safe guidance. There were records to support regular visits from a senior person in the organisation; records supported that the management of the home was monitored. Two residents financial records were looked at in detail and records showed that their money was stored and handled safely. This system could be improved to ensure it was easier to audit. Records were stored safely. Any concerns with records were referred to under the relevant outcome areas. Records supported that systems and equipment were safe and well maintained. Staff had been provided with regular training that would keep themselves and others safe. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must reflect 02/11/2009 current care needs and the action to be taken by staff to meet those needs. This will ensure residents receive the care they need. 2 8 13 Interventions to reduce any 01/10/2007 identified risks to residents must be recorded in the care plan. Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plans must set out in detail the action to be taken by staff to ensure all aspects of residents needs are met. This will ensure that staff will fully understand how residents needs will be met. 30/06/2010 2 8 13 The care plan must include details of any action to be taken to reduce or remove any identified risks. This will ensure residents are protected. 30/06/2010 3 25 13 Hot pipework must be covered. This will remove the risk of hot surfaces 23/06/2010 Care Homes for Older People Page 27 of 30 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 7 The care plans should include information about residents routines, preferences, likes and dislikes; this would help to ensure they received the care and support they both needed and wanted. Residents and their relatives should be involved in the development and review of their care; this will ensure they receive the care they both need and want. The use of bed rails should always be assessed and discussed with the resident or their relatives; this will help to determine whether it is a suitable method of restraint. Assessments of residents ongoing nutritional status and any concerns and interventions should be recorded for all residents to identify whether residents were at risk of malnutrition. Residents or their relatives should give their permission for staff to take over the management of residents medicines. Oxygen cylinders should be stored appropriately to prevent any injury to residents, visitors and staff. The contact information of local agencies who would be involved in any safeguarding alert should be included in the safeguarding procedure; this will ensure staff have the correct information to refer incidents promptly. The contact information of the relevant local agencies should be included in the whistle blowing procedure; this would ensure staff had the correct information to refer any poor practice promptly. Staff should receive training to support them with the Deprivation of Liberty Safeguards and Mental Capacity Act; this would make staff aware of their responsibilities when supporting residents with their decisions and choices. A senior member of staff should attend the local authority safeguarding update training; this will give them the skills and knowledge to update all staff with local policies. The detailed abuse policy should be returned to the procedure file to ensure staff had access to detailed information. The fire safety officer should be consulted about suitable gates to allow residents safe wander space from the 2 7 3 8 4 8 5 6 7 9 9 18 8 18 9 18 10 18 11 18 12 19 Care Homes for Older People Page 28 of 30 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 kitchen conservatory exit to external areas. 13 19 All areas noted during the tour of the home and discussed with the registered manager should be addressed; this will ensure the home is a pleasant and safe place for residents to live. Records of training should be up to date and reflect the skills and competencies of current staff. Systems should be developed to monitor whether staff were following policies and procedures and whether peoples needs were met The residents personal allowance system should be improved and balances audited to ensure residents finances are safeguarded. 14 15 30 33 16 35 Care Homes for Older People Page 29 of 30 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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