Care Home: Willowbank Rest Home

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What the care home does well The routines of the home are flexible and aim to allow residents their freedom and independence by enabling them to retain as much control over their lives as possible, thus promoting equality and diversity. Visiting arrangements are in place to suit the needs of individual residents. The health care needs of people living at the home are well met meaning that residents have confidence that the staff team would arrange for medical assistance quickly if they were unwell. The home is well managed, with good training provided for staff, the majority of the care staff team are now qualified. This means that people are supported by staff who have had their work practice assessed and are deemed to be competent workers. There is a good system to introduce people to the home, with up to date written information provided and needs assessment done, so they know their needs can be met at the home. People spoken with living at the home told us that they like the staff and got on well with them. One person described the staff team as, "kind and caring". Another person said that she got on well with the staff team and that she was, "Happy being with staff". What has improved since the last inspection? As recommended in the last key inspection report, the homeowners are now undertaking a monthly written report about the conduct and management of the home. A copy of these monthly reports is provided to the manager and were evidenced at the time of the site visit. These reports help to make sure that the homeowners are fully aware of what is going on in the home and whether residents are satisfied with the service provided. The report also formally provides the manager with information of their findings. The way the administration of controlled drugs is recorded has been strengthened. A second member of staff now checks the medication prior to administration and countersigns the controlled drug administration record to this effect. This double checking helps to prevent mistakes from being made. The range of activities made available at the home has been extended. This helps to provide residents with greater opportunity to participate in social activity and stimulation that meets their individual needs and expectations. What the care home could do better: All care plans should be of the same high quality, care plans should be comprehensive and detailed in order to provide staff with sufficient written information regarding each area of identified need to ensure that a consistent service is provided at all times. Whenever a risk is identified, a formal written risk assessment should always be undertaken with significant outcomes incorporated in the individual care plan. This would help to protect people.It has been recommended that any monies placed in safekeeping or taken out of safe keeping are countersigned by a second person to confirm accuracy of the transaction. Key inspection report Care homes for older people Name: Address: Willowbank Rest Home 42 Lancaster Lane Clayton Le Woods Leyland Lancashire PR25 5SP     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: Denise Upton     Date: 2 4 0 9 2 0 0 9 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 34 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) 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 Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Willowbank Rest Home 42 Lancaster Lane Clayton Le Woods Leyland Lancashire PR25 5SP 01772435429 01772435429 hazelhousecare@btconnect.com www.netleypartnerships.co.uk Willowbank Rest Home Limited care home 19 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care Home only - code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 19 Date of last inspection Brief description of the care home Willowbank Care Home is situated on the outskirts of Leyland, close to junction 28 of the M6 motorway, in a quiet residential area. Local amenities are close by. Bedroom accommodation is provided on the ground and first floor of the building and now consists of 19 bedrooms for single occupancy. There are spacious lounge areas available, where a range of activities take place. The home also has a separate dining room although residents may dine in the privacy of their own bedroom accommodation if they so wish. Willowbank Care Home is not registered to provide nursing care. Personal care is provided as required and specialised needs can be catered for. Any Care Homes for Older People Page 4 of 34 Over 65 19 0 Brief description of the care home nursing needs are referred to the community district nursing team. Information on the home is made available in the Service Users Guide, a copy of which is given to each new resident when they are admitted. This provides written information about the services and facilities available at the home. Visitors are made welcome at any time of the residents choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. The web address of Willowbank Care Home is www.netleypartnerships.co.uk Care Homes for Older People Page 5 of 34 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: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. This unannounced key inspection site visit took place during the course of a mid week day and spanned a period of approximately eight and a half hours. Twenty three of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the requirement and recommendations made at the last key inspection. We spoke with the homes manager, a senior carer, a care worker and the cook on duty. Later in the day some discussion also took place with the one of the homeowners. In addition, two residents who were at home were also individually spoken with and further discussion took place with two other residents in the lounge area of the home. This all helped to form an opinion as to whether Willowbank Care Home was meeting the needs and expectations of the people who live there. At the time of the site visit, Care Homes for Older People Page 6 of 34 twelve people were living at the home. Every year the manager is asked to provide us with written information about the quality of the service they provide. They are also asked to make an assessment of the quality of the service. This information, in part, has been used to focus our inspection activity and is included in this report. During the course of the site visit, a number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation and the laundry area. Details of current fees and what is included in the fees is available from the manager at the home. The last key inspection at Willowbank Care Home took place on 11th October 2007 and an Annual Service Review was undertaken on 25th September 2008. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: All care plans should be of the same high quality, care plans should be comprehensive and detailed in order to provide staff with sufficient written information regarding each area of identified need to ensure that a consistent service is provided at all times. Whenever a risk is identified, a formal written risk assessment should always be undertaken with significant outcomes incorporated in the individual care plan. This would help to protect people. Care Homes for Older People Page 8 of 34 It has been recommended that any monies placed in safekeeping or taken out of safe keeping are countersigned by a second person to confirm accuracy of the transaction. 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 9 of 34 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 10 of 34 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 moving into Willowbank Care Home are given information about the home and have their needs assessed so they will know if their needs can be met. Evidence: People are only admitted to Willowbank Care Home if their health, personal and social care needs could be met. The homes manager or a senior member of staff carry out an assessment of people considering moving into the home. This is completed in order to determine if the level of care and support required could be provided at the home. The people undertaking the initial assessment of strengths and needs are experienced in undertaking pre admission assessments. The prospective resident is visited in their own home or in some cases, in hospital. This provides an opportunity for the prospective resident to find out more about the home and for the manager to undertake a formal assessment. This information, along with any other relevant assessments conducted by other agencys such as health assessments, are taken into account. This collated information, along with any further information provided by Care Homes for Older People Page 11 of 34 Evidence: family or other advocates, provides the basis of the initial plan of care. The files viewed showed that good pre assessment information is gathered and that relatives are involved in this process where possible. Information includes health and social care needs and highlights any areas of risk. This enables the homes manager to make an informed decision as to whether the individual needs and requirements of a prospective new resident could be met at Willowbank Care Home. Once the assessment process is complete and the manager has made a decision, the prospective resident is provided with written information confirming the outcome of the pre admission assessment. Although the two residents individually spoken with could not really remember much about their admission to the home, the homes manager explained that each enquirer is provided with a comprehensive information pack that includes the recently redesigned brochure, a copy of the Service User Guide and Statement of Purpose, and a copy of the homes most recent newsletter. Prospect residents and their family are also encouraged to visit the home as often as they wish or the prospective resident can stay for a few hours and have a meal before making a decision about moving into the home. For prospective residents that are in hospital when the initial pre admission assessment takes place or are too unwell to visit the home, a photograph album illustrating different areas of the home is available to view when they are assessed by a member of the homes staff team. Willowbank Care Home does not provide intermediate care. Care Homes for Older People Page 12 of 34 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. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being and confidence that any health issue would be dealt with. Evidence: Each person has a written plan of care and three of these were viewed. However the quality of the care plans seen varied. For one person admitted some time ago, the care plan was detailed and gave staff clear written direction as to how the assessed needs and requirements of this person were to be met. This care plan covered a range of assessed needs such as personal hygiene, mobility, social and emotional support, nutrition, communication, pressure areas and sleep. A range of risk assessments were also available that helped to inform the individual plan of care. This enabled staff to provide an individualised, person centred service that was delivered in a consistent way. This also helped to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. Care Homes for Older People Page 13 of 34 Evidence: However in respect of another resident, although the pre admission assessment information available indicated that this person was diabetic, disorientated with no insight into capability and had difficulty in comprehending, there were no care plans or risk assessments in place in respect of these issues to direct or guide staff. Although staff spoken with were clearly aware of this persons holistic needs and how best to support her, and the resident herself felt that her care needs were being met, there should always be a detailed care plan in place to indicate the support or assistance required so that staff are not relying solely on verbal information sharing. In another instance the homes manager gave a good, detailed verbal account of how a resident was assisted when she became unwell. The action taken by staff was appropriate and immediate, however there was no care plan or risk assessment in place. It is essential that a detailed care plan for each area of assessed need is developed and made available to the staff team. This should clearly describe the individual assessed need and the actual support required from staff to meet that assessed need. Without this there is potential for mistakes to be made, misunderstanding by some staff of the actual support required, risk for the resident and an inconsistent service to be provided. In order to reduce or eliminate any identified risk it is important that when ever a risk is identified a formal risk assessment is undertaken with significant outcomes incorporated in the care plan. This is essential to make sure that the resident is protected and that all staff are clear about the way they should respond to a specific situation in an appropriate and consistent way. It was also noted that not all residents had a social activity care plan or religious needs care plan. For one person the personal profile stated that this person enjoyed days out, walking, music from the 50s and 60s and was a practising member of the Church of England. We were informed that this resident was enabled to participate in these chosen activities but there was no care plan in place to direct staff regarding this persons preferences or of any assistance required to undertake the activities of her choice. There should also be a specific care plan in place regarding medication that is based on the pre admission information and amended and reviewed accordingly. As previously stated in this report, some of the care plans evidenced did give good information for staff to follow but it is essential that all care plans are of the same good standard in order to make sure that staff have clear and detailed information about the individual care needs and requirements of each resident and to ensure that a person centred service is offered to all residents. Care Homes for Older People Page 14 of 34 Evidence: Residents and where appropriate their relatives, had been given opportunity to be involved in the care planning process, so that they could have some say into the care provided. There was also clear evidence of monthly reviews taking place with amendments to the care plan as dependency needs had changed. Residents spoken with in the lounge area of the home clearly felt that their individual needs were being very well met by the staff team. They also said that the staff team were Good and that they had no concerns about anything. A member of staff spoken with told us that sufficient information was provided regarding each resident and how best to assist them and that the manager also verbally explained the individual assistance required. The health care needs of people living at the home are well met. Each resident has a key worker that takes a special interest in them, staff get to know people well and can spot any changes in health and well being. There is a good relationship with health and social care professionals in order to maintain residents health and social wellbeing. An individual record is maintained of all health professional visits for each client. This ensures that a good record is kept of health care visits and the frequency of need. As part of the visit, we checked how medicines were being handled. There is a good system in place to make sure that medication is administered safely and as prescribed. All staff with responsibility for the administration and recording of medication have received appropriate training. The medication administration records of three people were viewed. These had been completed correctly and had a photograph of the person attached, this is good practice and helps prevent mistakes being made. Following a risk assessment, people are able to look after their own medication either totally or in part if this is deemed to be safe. It is understood that a locked facility is provided in individual bedroom accommodation for the safe storage of personal items such as medication. Medicines stock was seen to be organised, records were clearly presented and spare stock was stored securely. Records of medicines received into the home, given to people and disposed of were signed and up to date. However there was an occasional dose omission without explanation. This suggests that staff are not always signing the drug administration record immediately after the medication had been given. We were told that the supplying pharmacist carries out a monthly medication audit to make sure staff were giving and recording medicines correctly. When any mistakes were found action is taken immediately to help prevent them happening again. Hand Care Homes for Older People Page 15 of 34 Evidence: written entries on the drug administration record were seen to be signed, dated and countersigned by a second person. This is good practice so as to ensure that the hand written entry is correct for the protection of residents. There is a homely remedies policy in place and we also saw evidence of protocols in respect of when required medication. This is medication that is not taken on a regular basis. Although at the time of the site visit nobody living at the home required controlled drugs, there is a controlled drug storage facility and a controlled drug administration record book available. Residents spoken with felt that their privacy and dignity was well respected at the home. A carer also gave a good account of how she respected residents privacy and dignity when assistance with personal care was required. The health and personal care that people receive is based on their individual needs so they receive personal care in the way they prefer and in a way that shows respect for their privacy and dignity. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training, and through supervision arrangements. The preferred term of address of each resident is identified at the time of admission and always respected. Care Homes for Older People Page 16 of 34 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. People are able to take part in activities that suit their lifestyle and maintain their interests. Evidence: People living at Willowbank Care Home are now offered an increased choice of activities that is suited to their wishes and lifestyle. Prior to admission staff obtain as much information as possible about the social, cultural and leisure needs of people living at the home. This means that staff have the information they need to make sure that the care and support provided is right for that person. Peoples spiritual needs are also recorded so they can be given opportunity and any help they need to continue to follow their faith. However as previously stated in this report, a care plan is not necessarily available in order to advise and direct staff on how best to enable the resident to continue with their chosen activities. Since the last key inspection, and in consultation with residents, time has been spent in devising a programme of social activities to meet the needs, preferences and wishes of people living at the home. There is now good detail of activities that individual residents have enjoyed. A list of the weekly activities made available is displayed on a notice board in a communal area of the home and there is also a change of activity Care Homes for Older People Page 17 of 34 Evidence: record book to record if a planned weekly activity is changed. Activities made available range from dominoes, floor skittles, bingo, baking, manicures and a reminisce group undertaken with the assistance of an older persons champion who visits the home on a regular basis, to Songs of Praise, and outings in the homes mini bus. This included a trip to Blackpool illuminations and a garden centre visit that was planned for the day after the site visit. In addition, a summer fate has taken place and a Halloween party is planned. An outside entertainer visits the home periodically to entertain residents and video evenings are regularly arranged with chairs placed as they would be in a cinema, curtains closed and crisps and pop for the interval. The Annual Quality Assurance Assessment (AQAA) completed by the homes manager prior to the site visit taking place, told us that a music therapist also visits the home to help enhance the quality of life of people living there. There is also a reading group facilitated by a carer who reads a couple of chapters of a book to a group of residents, followed by further chapters at the following reading group meeting. The family of one resident who visit spend time doing crosswords with a group of residents. Religious festivals are celebrated as are birthdays with a birthday party, birthday tea, birthday cake, and a present. One resident spoken with individually told us that she preferred to spend most of her time in her individual bedroom accommodation watching television but that she did sometimes join in with in-house activities. Her decision was always respected. The current range of activities provided is now a real strength of the service and much enjoyed by residents. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visitors are made welcome at any reasonable time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. One resident spoken with confirmed that a family member visited and was always made welcome. People living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Residents are involved in choosing the colour scheme for their own bedroom and encouraged to personalise this personal space with their own important things. Individuals are also encouraged to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member takes on this responsibility. Details of advocacy services are also made available for residents Care Homes for Older People Page 18 of 34 Evidence: and their family to access if and when they choose. People living at the home that were spoken with all said that they liked the meals served. There is a four week rotating menu that was evidenced that showed a wide range of foods are offered. There is a choice of menu at each meal. As a result of comments made at a residents meeting, breakfast and the lunch time meal is now served at a later time. This shows that resident views are taken into consideration and acted upon. Breakfast is now normally served between 9:00am - 9:30am or when a individual resident chooses to get up and have breakfast and can be served in the dining room or in the residents bedroom. A cooked breakfast is always available on Sunday but can also be requested on any other morning. Although most residents choose to eat their meal at a similar time, a resident can request that their meal is served at a time to suit themselves and in a place of their choice. A bowl of fresh fruit was available in the lounge area for residents to help themselves to and drinks and snacks are served periodically throughout the day or on request. One resident spoken with told us that there was too much choice and that she would prefer a weekly rotating menu rather than the monthly rotating menu so that she would know exactly what was being served on each individual day. These feelings were not reflected by other residents spoken with. The same resident, whilst telling us that, Food well cooked, good cooks, said that she would like more cauliflower cheese and jacket potatoes at tea time rather than sandwiches. However she also said that she had not told anybody what she would like but felt confident this these foods would be provided more frequently if she asked for them. Discussion with the cook confirmed that menus are devised in consultation with residents and are a regular discussion item at residents meetings. Menus are changed periodically to reflect seasonal availability with fresh fruit and vegetables served at most meals. If a resident does not want the meal choices of the day, an alternative meal of the residents choice is always provided. Specialist cutlery and plate guards can be provided if required to aid independence and specialist diets can be accommodated in respect of medical, religious and cultural needs and requirements. Care Homes for Older People Page 19 of 34 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 a satisfactory complaints policy and adult protection policy in place. This, along with staff training helps to protect residents. Evidence: Willowbank Care Home has a complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the site visit, a record of complaints is kept that includes details of any action/investigation taken. The complaint procedure is displayed in a communal area of the home and written details of the complaint procedure are incorporated in the Service User Guide, a copy of which is provided to each resident. The AQAA also told us that the home operates an open door policy for residents and their relatives should they wish to discuss any matters of concern and that a culture is encouraged where by residents and their relatives feel comfortable in raising issues or making suggestions at an early stage. There is also a suggestion and comment box for residents wishing to raise issues who may wish to remain anonymous. A resident spoken with was very clear about who she would speak with if she did have a concern or complaint but then went on to say that she had no complaints and was quite happy with everything. Since the last key inspection three complaints had been received at the home. Two of the complaints were not upheld but some elements of Care Homes for Older People Page 20 of 34 Evidence: the third complaint were upheld in part. Systems and procedures were immediately looked at to make sure that people living at the home were protected. The complaints received were thoroughly investigated by the homeowners using the homes complaints procedure with a detailed record kept of what the complaint was, the method of investigation and outcome. Willowbank Care Home continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and procedure and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse that is regularly updated. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). Opportunity is also provided for this topic to be discussed during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Care Homes for Older People Page 21 of 34 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. A safe, pleasant and comfortable environment is provided. Evidence: Willowbank Care Home is a detached property, situated close to local shops, a Post Office and other community facilities. Accommodation is provided on the ground and first floor of the building and suitable equipment is provided to aid independence. The home is welcoming, comfortable, well maintained and provides good accommodation for the people who live there. All bedroom accommodation is now for single occupancy and residents are encouraged to personalise their bedroom with their own important things and can have a personal telephone installed to ensure privacy when making or receiving telephone calls. On the ground floor of the building there is a large, bright and airy lounge, a separate smaller lounge and a dining room. This means that people have a choice of where to spend their day as well as providing opportunity for activities to be taking place in one area of the home whilst providing a quiet environment for those who may not wish to participate. Recently the dining room has been redesigned to provide individual tables for one or two people to sit. At mealtimes, each table now has a separate pot of tea, milk jug and sugar for residents to help themselves to. Pictures and ornaments give a homely touch and there are photographs displayed of residents and staff enjoying social events. Care Homes for Older People Page 22 of 34 Evidence: Bedroom accommodation is provided on the ground and first floor. To ensure safety, all radiators in resident accommodation are guarded and there are thermostatic devices on all hot water outlets to prevent the risk of accidental scalding. A lockable facility is provided for the safe storage of personal items and all bedroom accommodation is fitted with a door lock to ensure privacy for the occupant. Since the last inspection a new fire alarm control panel has been fitted. This ensures that the fire safety system is up to date so that people are well protected. The role of the handyman has also been upgraded and now encompasses more responsibilities. We were told in the AQAA that maintenance scheduling has been improved to help eliminate routine tasks being overlooked and that there continues to be a rolling programme of repairs, renewals and maintenance to ensure that the physical environment at the home is maintained to a good standard. Residents spoken with had no concerns about the communal accommodation provided or their individual bedroom accommodation. One person told us that she liked her bedroom saying, Im happy, good, got my own pictures and bits and pieces and Teddy. There are a variety of policies and procedures to advise staff in the control of infection and all staff including domestic staff and the cooks, have been provided with infection control training. Refresher training is regularly provided. This means that all staff are aware of how to prevent cross infection for the protection of residents, relatives, the staff group and other people who may visit the home. Laundry facilities are sited in a designated area of the home and does not intrude on residents. The industrial washing machine has the capacity to meet disinfectant standards and floor and wall finishes are easily cleanable. Care staff carry out laundry tasks, with the night staff doing the bedding. The registered manager explained that there is a good system in place to ensure that residents freshly laundered clothes are returned to them. Protective clothing is provided for staff working within the home. Care Homes for Older People Page 23 of 34 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. National Vocational Qualification (NVQ) training is positively encouraged. This helps to ensure that people living at the home are supported by a staff group with the skills to provide a good quality service. Evidence: Staffing levels at Willowbank Care Home are determined by the assessed needs of residents accommodated. Care staffing levels are maintained throughout the waking day and all night staff have waking watch responsibility. There are sufficient ancillary staff employed to ensure standards in respect of domestic tasks and catering are well maintained. We were also told that additional staff would be provided as and when required to ensure that the assessed needs and requirements of each resident were met at all times. A key worker system is in place meaning that each resident has a designated member of staff who takes a special interest in their welfare. Residents and members of staff spoken with all said that there were sufficient staff on duty at all times to ensure that assessed needs were met. One resident told us, I get the help I need when I need it. The same resident did however go on to say, she would like staff to have more time in the afternoon to sit down and chat more often. A carer spoken with did say that staff do get time to sit and chat to residents or alternatively an individual resident on a regular basis, but this may be for a 10 -15 Care Homes for Older People Page 24 of 34 Evidence: minute period rather than much longer periods of time. The two members of the care staff team spoken with both said that there was a good staff group who were, All supportive and that there was Good staff, nice girls to work with and very capable. Another member of staff told us, There is a good staff team, supportive of each other, a happy place to be, its good. National Vocational Qualification (NVQ) training is promoted, with 10 of the 14 members of the care staff team having achieved at minimum, Level 2 of this award and a further two members of staff were about to complete this training. In addition, one member of staff has achieved the more advanced level 3 of this award and a further member of staff has successfully completed a NVQ Level 4. Domestic and catering staff have also achieved an NVQ qualification related to their work role. NVQ training is a nationally recognised qualification and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. From discussion and observation of records, it was clear that all newly appointed staff are provided with Skills for Care nationally recognised induction training for staff working in a care environment. This makes sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provided an appropriate level of care and support. Good additional training is also provided that is valued by staff. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is promoted by a well trained staff team. Further training is planned for some staff that includes a pandemic influenza briefing and deprivation of liberty safeguards training. Willowbank Care Home has a structured recruitment policy and procedure in place for the employment of new staff. This helps to protect residents and to ensure that only suitable people are employed at the home. Residents are also encouraged to be informally involved in the recruitment of new staff. Prior to the formal interview, applicants are invited to the home for a coffee and a chat with residents. After this, residents are asked what they thought and their views are taken into account when appointing staff. The staff files of three members of staff were viewed, two of which were of staff that Care Homes for Older People Page 25 of 34 Evidence: had been recently appointed. Records generally included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people that have been deemed unsuitable to work with vulnerable people. A recently appointed member of staff confirmed that the procedure had been followed and that she had not been allowed to take up her post at the home until the required clearances and references had been obtained and deemed satisfactory. However it was noted that in one instance, although two references had been obtained, one of the references was an undated, signed photocopy of a reference from a person located in another area of the country. It is essential that only original, signed and dated references are accepted that the company themselves had requested. A undated, photocopy of any reference may not be objective, up to date or accurate and it may be difficult to make sure that the reference was actually written by the person whose signature is at the bottom of the reference. There was clear evidence that a POVA First and a full Criminal Records Bureau (CRB) disclosure had been obtained, but the actual CRB disclosures older than twelve months old had been destroyed prior to the site visit taking place. From discussion with the manager and one of the homeowners, it would appear that they had been misinformed. There is a requirement that the complete CRB disclosure is retained until the next Care Quality Commission (CQC) site visit takes place. Once the CRB disclosures have been viewed as part of the site visit inspection, they can then be destroyed. A record was however kept of the date that POVA First and CRB disclosures had been received including those that had been destroyed. Care Homes for Older People Page 26 of 34 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. Willowbank Care Home is well managed so that it is run in the best interests of the people who live there. Evidence: Since the last inspection, a new manager has been appointed at Willowbank Care Home. The new manager is a registered nurse and has substantial experience of managing care homes for vulnerable people. In addition, the new manager has achieved the Registered Managers Award and has undertaken a variety of other recent training including Deprivation of Liberty Safeguarding training and a Safeguarding Residents Rights course. The Registered Managers Award is a professional qualification that all managers of care home are expected to achieve to make sure that the home is run in the best interests of the people that live there. From discussion with the manager and one of the homeowners, it is understood that an application to registered this person with the Care Quality Commission has now been submitted. In order for the manager to be registered with the Commission, this person with have to Care Homes for Older People Page 27 of 34 Evidence: demonstrate that they have the qualifications, experience and personal qualities to run the care home in the best interest of the people that live there. Residents and staff all spoke highly of the new manager describing him as supportive and runs the home well. There are clear lines of accountability within the home and external management. We were informed that one of the homeowners visits the home at least twice a week to talk with residents and staff and audit records but is also available for advice at any time. It is understood that the other homeowner visits the home on at least a monthly basis to look at the general running of the home and to reassess income and expenditure. This helps the homeowners to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. As recommended at the last inspection, the homeowners now produce a monthly written report on the conduct of the home, a copy of which is given to the homes manager. These monthly reports were evidenced. The information provided was clear, comprehensive and detailed. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, a survey for residents about a different aspect of living at the home such as entertainment, meals and mealtimes, personal care and care plans. This is provided on a monthly basis. Completed surveys are evaluated and outcomes recorded. Residents are informed of the outcomes and proposals to implement any change. It is understood that the format of residents surveys is about to be reviewed to allow for comments to be made rather than the current system of a tick box type survey. This will allow residents greater opportunity to express their thoughts and opinions about individual topics. We were also told that there are separate surveys for relatives and friends. These have been provided regularly of late because of some changes that had been introduced and the management team wanted to capture the views of relatives regarding the recent changes. Surveys are also regularly provided to other people that visit the home such as General Practitioners (G.P.s) District Nurses, the Chiropodist etc. In addition there are regular residents meetings that take place and a suggestion box is located in a communal area of the home. These give residents opportunity to air their views and opinions with other people or more privately by way of the suggestion box. Staff meetings and senior management meetings take place regularly and there is an annual residents general meeting to which relatives and/or representatives are invited to attend. We were told in the AQAA that this is considered to be a useful forum for sharing information collectively, updating each other and discussing plans Care Homes for Older People Page 28 of 34 Evidence: for future plans for improvement. An Older Persons Champion has now been appointed who was previously a resident at the home and is well known to a number of other residents. We were told in the AQAA that the role of the Older Persons Champion is to ensure service users have a stronger voice in the running of the home and to assist management and staff see things from a residents perspective rather than from a staff focus. It is understood that the appointment of the Older Persons Champion has been of value and has been of benefit for the people that live at Willowbank Care Home. In addition, the home has successfully retained the ISO and Investors in People external quality awards. These awards are only given when a high standard of service and management is provided. These inclusive internal and external quality monitoring systems are a real strength of the service and show that people are valued, their views and opinions are considered important and that the homeowners want to share their vision for the home in an open and transparent way with the people that matter. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. However where the home does retain monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate signed records of any financial transactions undertaken and there are secure facilities to store monies held. Some relatives choose to provide a set amount of money each month to cover costs such as hairdressing, chiropody and personal items. We were told that this system works well. However it is suggested that when a family member gives an amount of money on a monthly basis, the relative is asked to countersign the financial record to confirm accuracy of the transaction. Likewise if a resident is given actual money from their personal monies held in safekeeping, the resident should be asked to sign the financial record as agreement of the monies received. This would help to protect residents, relatives and staff. There was clear evidence that formal one to one staff supervision is taking place at least six times a year along with an annual appraisal. The outcomes of the regular one to one supervision, helps to inform the annual individual staff appraisal. This was confirmed by the supervision notes seen and through discussion with two members of staff individually spoken with. This means that staff have opportunity to meet privately with their supervisor in order to discuss work practices and training needs as well as any other issues relating to working at the home. All staff also receive daily informal supervision as part of the management role. Care Homes for Older People Page 29 of 34 Evidence: There is a good system in place with regard to the maintenance of the home. All staff have responsibility to record any areas seen that require attention, in the maintenance request log book. The assistant maintenance technician then has responsibility to undertake the required work and sign and date the log once the job is completed. This helps to make sure that maintenance tasks are completed in a timely manner, that the home is maintained to a high standard and safety is maintained for the benefit of the residents living there. Records relating to health and safety were seen. Records showed that equipment such as the call bell system, emergency lighting and fire equipment are regularly serviced and that the electrical installation and electrical equipment are also checked. Environmental risk assessments were in place regarding the physical environment of the home and in respect of individual residents. All staff receive mandatory health and safety training including, first aid training, manual handling training, food hygiene that includes infection control and fire safety. Refresher training is also provided on a planned basis to ensure that staff have regular up to date information to act on. All these checks along with the health and safety training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Older People Page 30 of 34 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 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Whenever a risk is identified, a formal risk assessment should always be undertaken with significant outcomes incorporated in the individual care plan. All care plans should be holistic in content and of the same high quality. Each area of assessed need should have an individual plan of care detailing the actual assistance required in order to meet that need and to guide and direct staff. This includes social, religious and medication needs and requirements. The drug administration record should always be signed immediately after the medication has been administered. The full CRB disclosure in respect of newly appointed staff should be retained until the next CQC site visit inspection. The reference accepted should be clearly signed and dated by the person giving the reference. Open references or a photocopy of a reference should not be accepted. References should only be accepted from people the company has actually requested a recent reference from. When a relative gives money to be placed in safekeeping, Page 32 of 34 2 7 3 4 5 9 29 29 6 7 29 35 Care Homes for Older People 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 the relative should be asked to sign the financial record to confirm accuracy of the transaction. Likewise a resident should be asked to sign the financial record to confirm receipt of any actual monies given from safekeeping. Care Homes for Older People Page 33 of 34 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - 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. 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