Care Home: Willowcroft

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What the care home does well The home makes sure that they know as much as possible about people`s care and support needs before they move in. People benefit from care plans that are comprehensive showing details about how their care and support needs are met and monitored. People make decisions about who provides their intimate personal care. People have good access to healthcare professionals. People can join in with different group activities and trips to events in other homes. People contribute to menu planning and benefit from a nutritious and varied diet. People benefit from a home that is comfortable, cleaned to a good standard and well maintained. There is a robust recruitment process, which means that people are protected from staff who are unsuitable. Staffing levels mean that people can do the things they want to and have staff available when they need them. Staff have good access to training that is relevant to the work they do. Staff have developed good relationships with people who use the service. People`s rights of dignity and respect are upheld by staff. Systems are in place so that the health and safety of people who use the service and staff is ensured. People who use the service and staff benefit from a manager who has improved the quality of the service in the time that she has managed the home. What has improved since the last inspection? Pressure damage risk assessments are more detailed. Medication errors had reduced following retraining of staff, competence monitoring and regular auditing by Mrs Crothers. Staff who failed to follow the medication policy and put people at risk of receiving the wrong medication, were disciplined and no longer work for the organisation. The home`s refurbishment programme is well underway with many improvements for people`s comfort. The staffing rota identifies who actually worked each shift. An increase in care support hours means that care staff have more time to spend with people who use the service. The recruitment of new staff members has brought more experienced and trained staff with qualifications to the staff team. Mrs Crothers lets us know when any events in the home affect people who live there. What the care home could do better: The daily records could be informative, for example, by staff recording what they observed, conversations and intervention, rather than writing "no problems". This would ensure that there is always good information about how people`s care and support needs are being met and monitored. Records must be kept of reasons, discussions and decisions about suitability, when employing staff who may have disclosed any convictions or cautions. To ensure a robust recruitment process. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willowcroft Odstock Road Salisbury Wiltshire SP2 8BG     The quality rating for this care home is:   three star excellent service 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: Sally Walker     Date: 2 9 0 7 2 0 0 9 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. 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. 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 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. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Willowcroft Odstock Road Salisbury Wiltshire SP2 8BG 01722323477 01722325947 manager.willowcroft@osjctwilts.co.uk 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) : The Orders Of St John Care Trust care home 42 Number of places (if applicable): Under 65 Over 65 21 1 1 21 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 0 The maximum number of service users that can be accommodated is 42. The registered person provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP- maximum 21 places Dementia aged 65 years and over on admission- Code DE(E) - maximum 21 places Learning disability aged 65 years and over on admission- Code LD(E)- maximum 1 place Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission- Code MD(E)- maximum of 1 place Date of last inspection Brief description of the care home Willowcroft is registered to provide personal care for 42 older people aged 65 years or older, 21 of whom may have dementia. The home was purpose built by the local Care Homes for Older People Page 4 of 31 Brief description of the care home authority in the 1970s. The accommodation is to two floors offering communal space on each floor. The home provides all single bedroom accommodation. A large well maintained garden is to the rear of the building. The home is situated on the south side of the city of Salisbury, close to all amenities and facilities that Salisbury offers. The registered provider is the Orders of St Johns Care Trust. The Registered Manager is Mrs Marilyn Crothers. She came into post in April 2007 and was registered on 17th July 2007. The care staffing rota provides for a minimum of one care leader and five care staff during the mornings, a care leader and four care staff during the afternoons and evenings and three waking night staff. Care Homes for Older People Page 5 of 31 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: three star excellent 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 unannounced inspection took place on 29th July between 9.25am and 6.15pm. Mrs Marilyn Crothers, the registered manager, was present during the inspection. The locality manager came to the home to be there when we gave feedback to Mrs Crothers. We spoke with people who use the service and staff. We looked at care plans, risk assessments, medication, activities, menus and staff recruitment and training records. We looked around the building. Before this inspection we asked the home to complete their Annual Quality Assurance Assessment (AQAA). This was their own assessment of how they were performing. It Care Homes for Older People Page 6 of 31 told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. We looked at the information that we had been given during the last year. This helped us to decide what areas to focus on during the inspection. The last key inspection was on 22nd July 2008. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? Pressure damage risk assessments are more detailed. Medication errors had reduced following retraining of staff, competence monitoring and regular auditing by Mrs Crothers. Staff who failed to follow the medication policy and put people at risk of receiving the wrong medication, were disciplined and no longer work for the organisation. The homes refurbishment programme is well underway with many improvements for peoples comfort. The staffing rota identifies who actually worked each shift. An increase in care support hours means that care staff have more time to spend with people who use the service. The recruitment of new staff members has brought more experienced and trained staff with qualifications to the staff team. Mrs Crothers lets us know when any events in the home affect people who live there. Care Homes for Older People Page 8 of 31 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 31 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 31 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 have all their care and support needs assessed before they move in. Evidence: Pre-admission assessments were carried out with people who were considering using the service. Mrs Crothers or senior staff met with the person and their family to discuss and assess care and support needs. Information was also gained from the care manager and other professionals involved with their care. People were asked about their social, as well as their medical history. Care plans were written from this information, so they could be available on the day that people moved in. One of the people we spoke with told us I didnt look round. My family chose it for me. Another person who was using the respite service told us Oh yes Id come again, Ive enjoyed my stay, but Im happy to be going home. Care Homes for Older People Page 11 of 31 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. Comprehensive care planning and continual assessment means that peoples needs are met and monitored. Peoples health and wellbeing needs are being met. People have good access to healthcare professionals. Efforts have been made to ensure that staff follow the procedures for medication administration. Staff uphold peoples rights to dignity and respect. Evidence: Each person had an individual care plan showing details of care and support needs and how they were to be met. Care plans were very detailed and showed good information about how people wanted their individual care to be provided. The care plans identified every aspect of peoples needs, including communication, diet, continence management, behaviour management, medication, mobility, bathing, how they wished to be addressed, risk of pressure damage, social and medical needs and personal care. People with diabetes had their blood glucose levels monitored and recorded in their care plans. The care plans recorded what levels were safe for each individual and what Care Homes for Older People Page 12 of 31 Evidence: staff must do if the levels changed. One of the staff told us that they had been trained by the district nurse to take the blood tests. They went on to say that the district nurse monitored peoples wellbeing and would give insulin injections, although currently peoples diabetes was diet controlled. Care plans showed that people who had diabetes had regular foot care. If people were assessed as needing to take more fluids, staff filled out a fluid chart so that they could make sure that people were drinking enough. We saw that the daily amounts that people should achieve were recorded in their nutritional care plans. Some people had additional food supplement drinks. People were weighed soon after they moved in and again every month. Significant loss was reported to their GP. Nutritional risk assessments were regularly carried out. The cooks were given information about peoples special dietary needs. Staff showed us the immediate care charts that they were filling out for those people who needed bed rest and turning, to reduce the risk of pressure sores. Pressure relieving equipment was in place. We saw that staff made sure people had their pressure relieving cushions on their dining room chairs, when they went from the sitting area to the dining room table. We saw information about preventative measures in reducing risk of pressure damage on the staff notice board. There were records for monitoring anyone who was at risk if they left the building unaccompanied. Consideration had been given to whether people were deprived of their liberty when at risk of leaving the building unaccompanied. Bathing risk assessments identified when people must never be left alone in the bath. People had their risk of falling assessed. We saw that care plans identified those people at risk, with guidance to staff on minimising the risk. We saw that people had outdoor shoes rather than slippers to walk around the home, further reducing any risk of falls. We saw that some people had had assessments from the falls clinic. Care plans showed details of different behaviours and how they were managed. Daily reports varied in the amount of detail that related to peoples care plans. Some staff were recording no problems without detail of how they had come to that conclusion or whether they had spoken to the person. We asked people about who provided their intimate personal care. One person told us a woman gives me a bath. The men bring me my breakfast. I was asked if I minded and I told them no. The locality manager told us that the organisation was producing a gender working policy. This sets out how intimate care is to be provided by staff of a Care Homes for Older People Page 13 of 31 Evidence: different gender to the people who use the service. Mrs Crothers told us that good relationships had been built up with the district nursing service following liaison meetings. The nurses came to the home on two days a week and had been given storage space for equipment and medical supplies. She told us that the nurses could be contacted at other times to provide treatments and advice. One of the staff who was a qualified nurse, but not employed in that role, liaised with the nurses on their visits and recorded outcomes of any treatments or advice in peoples records. The care plans documented details about any wounds and how they were treated. Staff were not carrying out any delegated nursing treatments. Staff had been trained by the district nurses to change stoma bags. One of the people we spoke with told us about how they were pleased with the healing of an ulcer on their leg. We looked at their care plan which showed details of how healing was monitored and evaluated, with body maps and descriptions of treatments. One of the staff had undertaken training from the RNIB (Royal National Institute of Blind People) for carers working and supporting people who have a visual impairment. They would cascade this training to other staff. They were keyworker to some of the people who had a visual impairment. On the day we visited a worker from the RNIB had assessed those people with a visual impairment to provide some aids and services. Mrs Crothers told us that she had sourced information for staff about different diagnoses and medical conditions so that staff could know more about how these affected some of the people who use the service. At the last inspection there had been a number of medication errors. Mrs Crothers had made sure that all care staff had been retrained and the process of administration of medication strengthened. We had concerns when we were not notified about the errors and that the member of staff involved in two of the errors had not been stopped from giving medication after the first error occurred. There had been no medication errors in the last year. Mrs Crothers had monthly meetings with care staff, discussed our guidance about medication and carried out disciplinary action with those staff involved, as they were not following the organisations procedure. The staff no longer worked for the organisation. Just before this inspection Mrs Crothers told us about another medication error and what she was doing to address the incident. The staff involved was not working in the home and was the subject of disciplinary process as they had not followed the homes procedure. Care Homes for Older People Page 14 of 31 Evidence: The care leader who had delegated responsibility for medication showed us the arrangements for peoples medication. Medication was kept securely in a locked facility. The arrangements for any controlled medication were checked every few days, as seen in the log. People could administer their own medication following a risk assessment. Staff could not give medication unless they had been deemed competent by either the manager or care leader responsible. Their own competency was checked by the organisation. Ongoing competence was further assessed, both formally six monthly and with spot checks. The care leader told us that they and Mrs Crothers had been looking at ways to tighten up medication procedures so that errors did not occur. Staff must sign if they took boxes of peoples medication from the main storage cupboard. Medication was given before mealtimes so as not to interrupt the meal. We saw that medication was also given at the proper prescribed time. We saw that staff signed the medication administration record immediately after giving medication. Staff giving medication wore a tabard to show that they must not be interrupted. Peoples care plans had body maps to identify where topical creams must be applied; areas were colour coded if different creams were applied to different areas. New peoples medication was checked with their GPs when they moved in, to make sure they were taking what was prescribed. We saw guidance to staff in the serverys about food that should not be given with certain medication. Care plans identified when to give medication that was prescribed to be taken only when needed. There was separate recording in the medication administration record for this medication, including times of administration so that people did not have an overdose. We saw that the organisation had published regular updates on managing swine flu in the home. Mrs Crothers had produced an action plan should people who use the service or staff become ill. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a range of group activities in the home. People and their families are asked about their social history so that activities can be focused on their individual interests. Things that interest people with a dementia are gradually being introduced. People are offered a range of interesting and healthy meals and they contribute to the menu planning. Evidence: The activities programme showed three activities a day including evening activities. The activities co-ordinator worked twenty hours a week. We asked the activities coordinator about providing one to one time with those people who did not necessarily want group activities. They told us that their main focus was on group activities, and that care and care support staff provided activities at other times. The activities coordinator put out different resources so that care staff could provide the activities on the programme. The programme for the day we visited was arts and crafts in the morning, knitting, crochet and sewing in the afternoon and listening to music in the evening. There was a bingo session in the dining room during the morning. Other activities included board games, word games, number games, barbecues, arts and crafts, guess the baby, and themed meals. The activities co-ordinator was undertaking Care Homes for Older People Page 16 of 31 Evidence: National Vocational Qualification (NVQ) Level 2 in activities. Mrs Crothers told us that she had asked for extra staffing hours for activities in the budget, but the budget had been suspended for the time being and would be considered again in September 2009. Mrs Crothers told us that she was collecting articles for reminiscence boxes. These were boxes of different items from the past which could stimulate discussion about events in peoples lives. She went on to say that some of the people with dementia had benefited from doll therapy. (Research has shown that some people with dementia have reduced anxiety and behaviours when dolls are available to them). A pack had been purchased from the Alzheimers Society to introduce memory walks. The activities co-ordinator told us that they produced a regular newsletter advertising the events for the month. They kept records of the group activities that people were involved in and how they had benefited from the activity. They also spoke with people about what they wanted to do. Nine people had asked to have regular whist drives and this was being organised. They told us that activities were planned with a positive outcome for people and gauged to different abilities; mental and physical. They told us that everyone was encouraged to go out on the trips, so that it was not just the same people going every time. The activity co-ordinator told us that they were currently working with some people and their families to gain peoples social history. This meant that activities could be more focused on peoples interest and what they liked to do. We saw that peoples visitors were made welcome with refreshments. One family told us that they had received a very good welcome on their first visit. One of the staff told us I feel it is important to make families welcome with a drink, its what the residents would do if they were in their own home. There were photographs on different notice boards of the activities that had taken place in the last few months. The activities person looked at the safety and accessibility of different places that people went to. We were told that two favourite places were a local shopping centre with tea rooms and a garden centre in the New Forest where people had tea and scones. A local theatre company came to the home at different times of the year to perform different shows. The organisation provided different activities throughout the year, for example, competitions, tea dances and garden parties. Staff had been involved in a boat race to raise money which was shared with a local Care Homes for Older People Page 17 of 31 Evidence: charity. People had also enjoyed a trip on the Kennet and Avon canal with a picnic lunch and cream tea. Two peoples families had arranged for supporters from Age Concern to take them out twice a week. Mrs Crothers told us that the mini buses that had been available from another home in the area were too old to use. A local taxi service was now used. There was an organ in one of the sitting rooms with candles and a cross for religious services. We saw that religious services from local churches were advertised on notice boards. The AQAA did not identify anyone with different faiths. Currently only one person used the computer set up in the entrance hall. Some of the people we spoke with told us that they enjoyed staff bringing in their children and dogs to see them. One person told us theres plenty to do but some of it is not to my taste. We asked them what they liked to do. They told us that they liked to go out with their family and were happy staying in their room watching television. Another person told us I love the singing and dancing. We had a lovely Christmas. They make a cake for you if its your birthday. The lunch and evening meal choice was written on a blackboard in the dining rooms. At lunch time we asked some people whether they could see the board and what was written on it. Those people sitting near the board could read the choices. One person told us they could not see the board because of reflected light. Mrs Crothers had photographed the different dishes on the menu, so that people had a better idea of what the different meals were. She told us the photographs would be displayed in the dining room each day. Individual menu cards were planned for each of the dining room tables. We looked at the menus. People had met with the chef to discuss the menus. Mrs Crothers told us that she had introduced weekly surveys for people to comment on the quality of the meals and suggest dishes for the menus. People who used the respite service were asked about the meals. People could have eggs cooked to their liking every day and a cooked breakfast on Wednesdays and Saturdays. We saw the lunch being served in one of the dining rooms. People were shown a choice of two hot dishes and a salad. The meal was brought from the kitchen and served from a hot trolley. There were jugs of juice on the tables for people to help themselves to. There was no choice for pudding but some people were given low fat yoghurt. Bowls of fresh fruit were available on the dining room tables for people to help themselves to. The evening Care Homes for Older People Page 18 of 31 Evidence: meals were hot snacks or sandwiches and a pudding or cake. One person we spoke with told us the food is very good. I can recommend it. They told us they had been asked about what they liked to eat. Another person told us the food is most lovely. If I dont like something they give me something else. Ive put on weight since Ive been here. The local Environmental Health department had recently inspected the kitchen and given the home the maximum five stars. Care Homes for Older People Page 19 of 31 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. Complaints are taken seriously and thoroughly investigated. Systems are in place to protect people from abuse or harm. Evidence: The organisation had recently reviewed and revised its complaints procedure and documentation. We asked people what they would do if they wanted to complain about the service. One person told us I would talk to staff, they would deal with it. Mrs Crothers kept a record of all complaints with details of her investigation outcomes and responses to the complainants. We saw copies of the local safeguarding booklet on the office notice board. We talked with staff about how the safeguarding procedure operated. One staff gave us an example of how they had used the procedure recently and discussed how they had made the decision to refer the incident with other staff on duty with them at the time. Staff had been trained in safeguarding vulnerable people. We spoke with the administrator about the arrangements for any money that the home might keep safe for people. They told us that they were no longer responsible for the few people who they had collected pensions for. People who did not manage their money or have a power of attorney, had their finances managed independently by the funding authority. Some people kept small amounts of cash in the homes safe. Care Homes for Older People Page 20 of 31 Evidence: Only the manager, administrator and senior staff had access to the safe. Records and receipts were kept of all transactions. Two signatures were required for all transactions. The records were regularly audited by the administrator and Mrs Crothers. The administrator gave us an example of using the safeguarding process when there were concerns about a persons finances. They told us about the positive outcome for the person. They told us that they gave people and their relatives advice about fees. They told us that various people would come to the office to talk with them during the day. They said that they felt they were another avenue if people wanted to talk about anything that they were not happy with. Care Homes for Older People Page 21 of 31 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. The homes programme of refurbishment is well underway. The home looks fresher and more comfortable for people. Evidence: Significant refurbishment had taken place to make the home more comfortable for people. In the AQAA Mrs Crothers told us we have repainted the communal areas and have redecorated several bedrooms. Six bedrooms have been fitted with new vanity units and bedroom furniture. New armchairs have been purchased, the style and colour were chosen by the residents. A new fire alarm system will also be installed. At the request of the residents we intend to purchase smaller dining tables for more intimate dining and we will also purchase more garden furniture. Our main project will be on the upgrade of bedrooms as we are scheduled to have more vanity units and bedroom furniture upgrades. Communal areas had been carpeted. New curtains had been put up in peoples bedrooms and communal areas. Mrs Crothers told us that the sluices would be replaced the following week and a bathroom refurbished the following month. All of the bedrooms are singles. People had personalised their rooms with some of their own furniture, pictures and ornaments. Care Homes for Older People Page 22 of 31 Evidence: Signage for the way to the lift was located along the corridors. Toilets and bathrooms had signs on the doors. Mrs Crothers told us that as a result of dementia training on recent research into an environment that people with dementia can make sense of, toilet and bathroom doors were in the process of being painted a different colour for easy identification. There were seating areas along the corridors so that people could take a rest when walking down the corridors. One of the people we spoke with told us the laundry lady is wonderful. She looks after my clothes and brings things back to me. The home was cleaned to a good standard. We saw that housekeeping staff were prompt at cleaning rooms when people had continence accidents. Mrs Crothers told us that carpets were renewed when constant cleaning did not address odours. We saw that those areas of the home not always visible were also cleaned to a good standard: the undersides of toilet surrounds and bath seats, under beds, wheelchairs, commodes and dining room chairs. Care Homes for Older People Page 23 of 31 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. People are supported by enough staff with qualifications and experience at times when they need them. A robust recruitment process means that people are protected from staff who are unsuitable to work with vulnerable people. Staff have good access to regular training. Evidence: The care rotas showed that there were a minimum of five care staff with a care leader in charge of the shift and a care support staff during the mornings, seven days a week. During the afternoons and evenings there were a minimum of four care staff and a care leader. At night there were three waking night staff. Since the last inspection a number of staff had left and new staff appointed with a range of experience, qualifications and training. In the AQAA Mrs Crothers told us our staffing levels have improved this year allowing 30 extra hours for a carer and 20 hours for care support. All new staff are inducted into their role. In the AQAA Mrs Crothers told us that the induction training of new staff contained a module on equality and diversity. One staff member who had worked at one of the other homes in the organisation, told us that they had had a further induction into their role at Willowcroft. Mrs Crothers told us that the induction of new staff had been reviewed and revised to include basic good care practice. This was so that assumptions were not Care Homes for Older People Page 24 of 31 Evidence: made about staff being able carry out basic care and task and expectations of the role were clear. New staff start by doing e-learning (computer or DVD learning packages) and then shadow a more experienced member of staff until their Criminal Records Bureau certificate (CRB) comes through. During their induction new staff had supervision every two weeks. Since the last inspection Mrs Crothers had recruited extra care support hours. The care support staff members did not provide any personal care. They made beds, helped with serving meals and activities. The rota provided a care support for the mornings and afternoons for five days a week and mornings at the weekend. Care staff told us that this meant that they were able to spend more time with people who use the service. We looked at staff recruitment files. Most of the documents and information that we required by regulation were on file. We saw that discussions with new staff members about any disclosed convictions or cautions were not always recorded or any decision as to why they were considered suitable to work with vulnerable people. Mrs Crothers told us that people who use the service are encouraged to join the interview panel. One person selected questions to ask candidates and contributed their observations to the interview process. One of the care leaders showed us the staff training arrangements. The organisation provided e-learning with core subjects which staff are required to undertake. This was either done on line or with DVDs or CDs for staff to watch and discuss. The care leader was a qualified trainer. We asked them about their own training. They held NVQ Level 3 and had recently undertaken training in the Mental Capacity Act 2006 and Deprivation of Liberty. They had trained in supervisory management. All staff members had access to training that is appropriate to their different jobs. The administrator told us that they had received training in dementia and would also like to do training on mental health. One staff member told us that they talked about training needs at supervision and could request any training that was not on the training plan for the year. Other staff members told us about training they had undertaken which included: prevention of pressure damage, first aid, moving and handling, mental health, the Mental Capacity Act 2006, safeguarding people, blood glucose testing, food hygiene, medication, health and safety, use of oxygen and nebuliser, care of the dying, using life histories and dementia care. They said that they could do the elearning either on the homes computer or access from home. The organisations own specialists had provided training in mental health. The Parkinsons Disease Society had also provided training. The RNIB had provided training in working with people with a visual impairment. The local hospital had provided training in care of a dying patient, communication and end of life care. Care Homes for Older People Page 25 of 31 Evidence: Mrs Crothers told us that the organisations training manager was going to provide a different training course in dementia as all staff had now done the Alzheimers Society course. Staff told us that different staff group meetings were held every six weeks. They said they could contribute to the agenda which was posted in the care office. We saw that staff engaged with people when they met them along the corridors. Staff greeted people and spent time talking with them and asking them how they were. One of the people we spoke with told us the staff are kind and understanding. But they are short of staff. Another person said I like it here. The staff are kind, they put their arms around you. Care Homes for Older People Page 26 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is well managed. People who use the service and staff benefit from a manager who is qualified and experienced in managing care services. Mrs Crothers has improved the quality of the service in the two years that she had been the manager. The home is run in peoples best interests and their views taken into consideration. Systems are in place to ensure the health and safety of people who use the service and staff. Evidence: Mrs Crothers has managed the home for two years. She has NVQ Level 4 in management and care and the Registered Managers Award. She took over the home after a period of time when the home had been without a manager that stayed for any length of time. Mrs Crothers was trained as a nurse but is not on the register or employed in that capacity. She has many years experience of providing care to older people both as a provider and manager. Mrs Crothers told us that she had enrolled to undertake a qualification in dementia care. Care Homes for Older People Page 27 of 31 Evidence: Mrs Crothers has worked well with us and let us know about any significant events as they happen in the home. She has also let us know what she has done to address any issues. Each member of the senior care staff has a delegated area of management responsibility overseen by Mrs Crothers. The homes annual quality assurance had been carried out by an external company. Mrs Crothers told us that when the report was received she would provide an action plan showing how the home would address any recommendations. Mrs Crothers had recently sent surveys to people who use the service, their family and others involved in their care. She told us that she was collating the feedback from people who use the service which would inform the next quality audit. Other surveys were fed back to the organisation. Regular residents meetings were held with minutes displayed in large print on the notice boards. The minutes showed what Mrs Crothers had done about different things that people had discussed. In the AQAA Mrs Crothers told us that the monthly meetings are chaired when possible by a resident with the support of members of staff from different departments. Mrs Crothers told us that the unannounced visits carried out on behalf of the organisation were being done by other managers of homes. In the AQAA she told us that the locality manager carried out organisational visits. Staff told us that they had access to the locality manager during her visits and to anyone else from the organisation who visited. The organisation contracted for staff training in fire safety, fire risk assessment and maintenance provision of fire safety equipment. Care Homes for Older People Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Records must be kept of 30/09/2009 discussion and decisions in employing anyone who may have convictions or cautions. So that people are protected from unsuitable workers. 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 Staff should consider writing what they observed, conversations and intervention in the daily records rather than writing no problems. 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