Care Home: Willowbrook

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Willowbrook Willow Crescent Oakham Rutland LE15 6EH two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Cowley Date: 1 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Willowbrook Willow Crescent Oakham Rutland LE15 6EH 01572771001 01572771028 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rutland House Community Trust Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 10 Number of places (if applicable): Under 65 Over 65 10 10 0 0 learning disability physical disability Additional conditions: No person falling within the category PD may be admitted to the home unless that person also falls within category LD ie dual disability. The Care Home will provide personal care to service users who fall within the following service user categories; Learning Disability (LD), Physical Disability (PD). Maximum number registered 10. Date of last inspection A bit about the care home Willowbrook is a care home for people with learning difficulties, some of who also have physical disabilities. The accommodation was purpose built in 1995 and is ground level only. The home has ten single bedrooms, a large lounge/dining room, a `quiet? lounge and a small conservatory and atrium. The home has gardens with seating areas and the administration of the home is undertaken in a separate building located within the grounds. Willowbrook is approximately one mile from the centre of Oakham, which has a range of amenities including a swimming pool, churches, shops, pubs and a library. 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted five hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three of the people living at the home by meeting them; talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also met four other people who live in the home, the Manager, Deputy, and three support workers. Two surveys from the people who live in the home, five relatives surveys, and three staff surveys were returned to CSCI prior to the inspection. Comments made in these surveys are quoted throughout this report. What the care home does well We visited Willowbrook on a Sunday afternoon and found four staff on duty caring for nine service users. The atmosphere was friendly and welcoming and the people who live there appeared happy and settled. One of them showed us round the home which he seemed proud of. We saw that the home was spacious with a large communal lounge/dining room which overlooks the garden, and a smaller quiet lounge. All bedrooms were single and those we saw were a good size and personalised to reflect the hobbies and interests of the occupants. Overall the premises were homely, comfortable, and well decorated and maintained. We received good feedback about the home from the relatives and staff who completed surveys prior to the inspection. One relative wrote, This care home keeps the residents safe. And a member of staff told us, The service is passionate about the residents. All the people who live in the home have their own programme of activities. Most attend a local day centre where they do cooking, arts and crafts and sport. One of the people who live in the home said, I love shopping, particularly Christmas shopping. The staff are taking me on Friday. Another told us in sign language, which staff translated, that he likes bowling. The home has a central kitchen where food is prepared. One of the people who live in the home told us The food is nice here and theres plenty of choice. I like fish and chips - you cant beat them. Sometimes they buy them, sometimes they make them. Another told us in sign language, which staff again translated, that his favourite foods were chips and mashed potatoes. The staff on duty during the inspection were friendly and helpful. We saw they got on well with the people who live in the home. They were observed working closely with them and helping them to make choices. One service user told us, The staff are kind and I like XXXX (key worker) because shes nice. Relatives comments included, The staff have empathy, and The physical care and support for the residents is good. What has got better from the last inspection What the care home could do better Menus lacked detail and did not always say what people actually had for their meals. A proper record must be kept and this will assist in monitoring nutrition. Some Health Action Plans need of updating as key information has changed. Medication storage facilities should be checked to ensure they meet current legislation. The premises should be audited to ensure that minor repairs are not left outstanding. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kim Cowley Edgeley House Tottle Road Riverside Business Park Nottingham NG2 1RT 011 5934 0900 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. People who want to come to the home have their needs assessed to ensure it is suitable for them. This judgement has been made using available evidence including a visit to this service. Standard 2 was inspected. Evidence: People who want to live at Willowbrook first have a written assessment to see if the home is suitable for them. The Manager or Deputy completes this, taking into account their views, and the views of their significant others. Health and social care staff who are involved in their care are also consulted. This helps to ensure that the home will be able to meet peoples needs if they decide to move in. Prospective service users are then invited to visit the home as many times as they like, staying overnight if they wish, until they are ready to move in. There have been no admissions since the last inspection as the service user group is fairly stable. and most have been in the home long-term. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. Detailed care plans help staff to identify and meet the needs of the people who live in the home. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, and 9 were inspected. Evidence: All the people who live in the home have care plans. These help to ensure the care provided fits in with their lifestyle and meets their particular needs. The plans cover the health, personal and social needs of the person in question, and their likes/dislikes and preferred routines. We found care records to be person centred and user friendly. They were sufficiently detailed with a minimum of three entries made each day. This will help to ensure that staff are up to date with each service users progress. A member of staff told us, When residents needs change it is discussed at the weekly team meeting and if need be residents families are informed. We saw that staff had worked effectively with people with challenging behaviour. The home has particular expertise in this area, and records showed they are knowledgeable about how best to provide care for this service user group. The people who live in the home are encouraged to make decisions and take Evidence: responsible risks. Staff only intervene if there are serious concerns about their well being. This helps the people who live in the home to increase their independence and decision making skills, while at the same time remaining safe. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. Daily living and social activities enable the people who live in the home to lead full lives and grow in independence. Menus records are in need of improvement. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16, and 17 were inspected. Evidence: Most of the people who live at Willowbrook attend a local day centre where they take part in a range of activities including cooking, trips out, bowling, sport, and arts and crafts. The Manager told us there have been recent changes at the day centre, which may affect their schedules. She said she would be advocating for them to ensure they continue to have the opportunities to take part in activities they enjoy. One of the people who live in the home said, I love shopping, particularly Christmas shopping. The staff are taking me on Friday. Another told us in sign language, which staff translated, that he likes bowling. Those who dont attend a day centre take part in activities in the home organised by the care staff. A PAT dog and handler visits two service users who like animals. Everyone who lives in the home has at least one holiday a year, and regular trips out in one of the homes two minibuses. Evidence: Relatives of the people who live in the home are welcome to visit at any time and are invited to attend social occasions at Willowbrook. The Manager told us relatives can have as much or as little involement as they wish. Staff also keep them up to date by telephone and letter. The majority of the people who live in the home are out in the community during the day so they take packed lunches with them. Those that stay at Willowbrook have a light lunch, usually salad or sandwiches. In the evening a hot meal is prepared for everyone by the staff team, who are all trained in basic food hygiene. Some of the people who live in the home are on soft or other special diets and these are recorded in their care plans. One of the people who live in the home told us The food is nice here and theres plenty of choice. I like fish and chips - you cant beat them. Sometimes they buy them, sometimes they make them. Another told us in sign language, which staff translated, that his favourite foods were chips and mashed potatoes. We looked at the homes menus and found that lacked detail and did not always provide details of the food actually served to each of the people who live in the home. This was discussed with the Manager and it was agreed that in future a more accurate record would be kept. This is important for monitoring nutrition and also to provide evidence that everyone who lives in the home is having a balanced and wholesome diet. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. The people who live in the home have their personal and health care needs met in the way they want by staff in the home. Some information on care records needs updating and medication storage facilities shoud be checked to ensure they are suitable. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20 were inspected. Evidence: The people who live in the home are encouraged to be as independent as possible and are supported to care for themselves. Where necessary, support and guidance is offered in a sensitive and flexible manner. Care plans provide the information staff need to provide appropriate help and support and alert them to each individuals likes and dislikes. Records showed the people who live in the home use local health care services, for example GPs, opticians and dentists. All have Health Action Plans in place which help staff to ensure their health care needs are met. However when we looked at these we found that some were in need of updating. For example one hadnt been reviewed since 2005 and key information (identified during the inspection) had changed. All care records and contact details must be kept up to date to ensure needs are met and communication maintained with significant others. We looked at medication to see if it was safely stored and administered in the home. The Manager told us that staff are trained in-house to look after medication and two senior staff have completed a Medication Trainers course to help in this process. Most of the homes medication is kept in a purpose-designed trolley, but some is kept in a Evidence: wooden cupboards. These may not be secure enough and the home should contact their pharmacist to get advice on their suitability. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. Staff know how to safeguard the people who live in the home and help them express any concerns they might have. However they need to be clearer about when an incident needs to reporting to CSCI This judgement has been made using available evidence including a visit to this service. Standards 22 and 23 were inspected. Evidence: Staff at Willowbrook encourage the people who live in the home and/or their representatives to speak out if they have any concerns or complaints. The homes complaints procedure is displayed in the entrance hall in both a written and pictorial format and a copy is given to everyone who moves in. Most of the people who live in the home are unable to complain if they are unhappy about anything due to their communication difficulties. However staff said they were aware if something is upsetting them due to their behaviour and body language, and take appropriate action. One service user who was able to give her views told us, If somethings bothering me I tell the staff. They are good to talk to if I have a problem. And one of the people who live in the home told us in his survey that he would ring his relative if he wasnt happy about any aspect of the home. A member of staff told us, If anyone has concerns and they do not want to discuss it with a staff member or management they can contact a Trustee or phone their social worker or contact CSCI. There have been no complaints about the home since the last inspection. Ongoing safeguarding training is provided to all staff. Policies and procedures on safeguarding are in place and in discussions staff knew what to do if they became Evidence: concerned about the well being of one of the people who live in the home. However there was a lack of clarity about who should be notified if an untoward incident occurs, for example an altercation between two service users. In these circumstances consideration should be given to contacting social services and completing a Regulation 37 for CSCI. It is recommended that staff familiarise themselves with the relevant guidance concerning notifiable incidents, including those relating to safeguarding. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. The home is community-based, comfortable, and well maintained. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30 were inspected. Evidence: One of the people who live in the home showed the inspector round the living accommodation. The home is spacious with a large communal lounge/dining room which overlooks the garden, and smaller quiet lounge. All bedrooms are single and those we saw were a good size and personalised to reflect the hobbies and interests of the occupants. Bedrooms for service users with physical disabilities were well-equipped with moving and handling equipment. In discussion we found that one of the people who lives in the home has their own profiling bed. However in discussion it was unclear who is responsible for maintaining and servicing this bed. The Manager told us this is being addressed and she will ensure the bed is properly maintained and serviced as necessary. Some of the people who live in the home have ceiling fans in their rooms to keep them cool which helps to reduce the risk of seizures. Coloured lights are also used to create a relaxing environment. Since the last inspection the quiet lounge been refurbished. It now has new furniture and a new carpet installed. A couple of the rooms we saw needed minor repairs. One had a broken cupboard door and another has a loose handle on the chest of drawers. We also saw that some areas were in need of re-painting and re-plastering. It is recommended that an audit is carried out to see what improvements are needed, and Evidence: that these are carried out as necessary. All the areas we inspected were clean and fresh. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. Friendly and professional staff meets residents needs. This judgement has been made using available evidence including a visit to the service. Standards 32, 34 and 35 were inspected. Evidence: The staff on duty during the inspection were friendly and helpful. We saw they got on well with the people who live in the home. They were observed working closely with them and helping them to make choices. One of the people who lives in the home told us, The staff are kind and I like XXXX (key worker) because shes nice. Relatives comments included, The staff have empathy, and The physical care and support for the residents is good. Staffing levels were good but one relative told us,Over the past months with the large turnover of staff, we feel we have lost the closeness and contact we have have experienced previously with the carers. Records showed that some staff have left recently, but a core of staff remain and they have provided continuity for the people who live in the home. Recruitment procedures were discussed with the Manager. She told us that all staff are subject to CRB and POVA checks, and references are obtained. Staff receive good training opportunities at Willowbrook. One member of staff told us that he is being supported to do a two years palliative care course while working at Willowbrook. Other staff comments about training and supervision included: Im very impressed with the standard and level of training given and offered to each individual staff member in every role from maintenance to management. We have Evidence: regular supervisions and appraisals where we can discuss any problems and any progress. The training is very good and we are always getting updates. The Manager is always here for use to discuss our progress and we have regular appraisals and supervision. However one member of staff felt the induction was too basic. They told us I felt i needed to shadow more and have more free time to read the residents care plans more thoroughly. The staff induction should be reviewed to ensure it is suitably comprehensive and that staff have enough time to familiarise themselves with all aspects of the home before they start work unsupervised. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Quality in this outcome area is good. The home is safe and well managed and the people who live there are involved in the way it is run. This judgement has been made using available evidence including a visit to this service. Standards 37, 38, 39, and 42 were inspected. Evidence: Since the last inspection a new Registered Manager has been appointed. Previously the homes Training Officer, she has nine years experience in care, NVQ 4 in Care and the Registered Managers Award (recognised qualification for people who run care. She is running the home effectively, focusing on teamwork and service user involvement. A member of staff told us, The Manager is very supportive in every way. Residents are very well looked after. The Manager and staff, as far as possible, involve the people who live in the home in its running. The Manager told us that residents meetings are not always effective, due to the differing communication skills of the people who live there. Although some are able to give their views verbally, others must be represented. Where possible, staff work closely with families to try and ensure the voices of all the people who live in the home are heard. Annual surveys are sent out to relatives to give them the opportunity to comment formally on how the home is running. Polices and procedures are in place for safe working practises and the premises are Evidence: risk assessed. Records showed that the maintenance of the property and its safety systems are up to date. Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action 1 17 17 A record must be kept of the 16/01/2009 food actually served to each of the people who live in the home. This will assist in monitoring nutrition and providing evidence that everyone who lives in the home is having a balanced and wholesome diet. 2 18 17 Care records and contact details must be kept up to date To ensure needs are met and communication maintained with significant others. 16/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 20 23 The homes pharmacist should be contacted to check if the cupboards used for medication storage are fit for purpose. Staff should familiarise themselves with the relevant guidance concerning notifiable incidents, including those relating to safeguarding. The premises should be audited to identify where repairs and other improvements are needed, and these should then be carried out. The staff induction should be reviewed to ensure it is suitably comprehensive and that staff have enough time to familiarise themselves with all aspects of the home before they start work unsupervised. 3 24 4 36 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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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