Care Home: Willows Nursing Home, Blacon

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What the care home does well The information that tells people how the service works (the statement of purpose and service users guide) is clear and detailed to give people the information they would need to help them decide whether the Willows is the right home for them. People had received checks of their individual needs before they moved into the home. This meant that they and the staff of the home had the information they need to decide if the person`s needs can be met at the home. The home has an established staff team who were keen for good standards to be maintained. Residents` plans of care and individual case notes on the whole were well written and reflected each person`s needs. This helps to make sure that each person living at the Willows received the care and support they need in the way they prefer. There is an activities coordinator employed at the Willows. They provide a wide range of activities and entertainments and people who live in the home confirmed there is always something happening in the home that they can join in with. These activities help to keep people busy and given them a chance to join in social occasions. A good standard of hygiene was seen throughout the home and the standard of decor and furnishings was good. People`s bedrooms were individualised with their own possessions and thought has been given to making sure there is enough light and heating throughout the home. Thought has been given to colours within the dementia care unit and strong colours have been used on the corridors to promote different types of mood. People who live at the Willows said, "The home does everything well. Its a lovely caring place. I always like the meals", "Staff are always available when you need them. I always like the meals. They provide good quality and hygienic service and very good care" and "Meals are of a good standard. Bank holidays celebrated and made fun. The new manager has made some improvements". Relatives commented, "Since the management of the Willows has changed , great improvements are being made to give a better quality of life for the residents. An entertainments manager has been appointed and now they can paint, play games, go for walks etc. The difference this has made to my relative`s wellbeing is amazing. Meetings for families and staff to be arranged will help families understand and come to terms with their situation and an opportunity to voice concerns. The staff are kind caring people" and "The staff are usually there when I need them. It is very friendly with clients and visitors. They make everyone feel welcome. Most staff to try to be interactive with clients. There are some excellent staff here. They try to keep the clients active and do things with them. I reckon they are doing the best they can and I know I can ask the staff anything and I will get a truthful answer". Staff told us, "My manager regularly gives me enough support and meets with me" and "The level of care for the residents is of the highest standard. Training for the staff is also at a high standard". What has improved since the last inspection? Most of the requirements and recommendations made at the previous inspection visit have been met. Outstanding requirements and recommendations have been remade in this report. The information gathered about the needs of the people who are going to move in has been improved and more detailed information is available, so that people are confident that their needs have been assessed and can be met by the home. Improvements have been made in the care plans; these are now well written and good information is available. Systems for supporting people to walk safely have been improved and the way people`s decisions are reflected within the care plans has been developed and incorporated into the plans of care. The way that controlled drugs are recorded has improved so that people who live in the home can be sure that medicines are recorded appropriately and in a safe manner. Training on safeguarding adults has been undertaken by all the staff so that they are aware of what abuse is and what to do to make sure that people living in the home are protected from harm. What the care home could do better: Two requirements were made; the manager of the home must apply for registration with the Care Quality Commission, so that the home is run by an suitably competent and qualified person and staff must have mandatory training so that people who live in the home are cared for by suitably trained staff. Several recommendations were made and areas for improvement included, updating the statement of purpose and service users guide to ensure that accurate information is available to people and other formats of these documents should continue to be developed so that a range of formats are available in line with individual peoples needs. Care plans should be developed in a person-centred way so that the information they contained is written from the individual`s perspective. Also development of the recording of activities should be considered so that significant information is captured and used to develop suitable activities for each individual person. Specialist training, formal supervisions, annual appraisals and staff meetings all need to be brought up to date so that people who live at the home are supported by a staff team that is well trained and supported by the management of the home. Relative support meetings and surveys to the people who live at the home, relatives and other professionals should be undertaken so that people`s views of the home can be documented and used in the future planning of the service. Areas where people who live at the home, relatives and staff thought improvements could be made included: the laundry; more observation and attentiveness from staff to clients; some staff not showing respect or care for clients; and staff training and supervision. Other comments included: some bedrooms could do with refurbishment and better communication is needed between the care staff and kitchen staff regarding dietary requirements of new residents. Key inspection report Care homes for older people Name: Address: Willows Nursing Home, Blacon Treborth Road Blacon Chester Cheshire CH1 5RP     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: Maureen Brown     Date: 1 2 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Willows Nursing Home, Blacon Treborth Road Blacon Chester Cheshire CH1 5RP 01244374023 01244379228 manager.willows@m-a.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Mohammed Hussain,Mrs Anwar Hussain,Mr Naveed Hussain Name of registered manager (if applicable) Type of registration: Number of places registered: care home 73 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users 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. Dementia - Code DE. The maximum number of service users who can be accommodated is: 73. Date of last inspection Brief description of the care home Willows Nursing Home is a single storey building situated in the Blacon district of Chester. The home is conveniently situated for local shops and other communal facilities in Blacon, and there is regular public transport into Chester city centre. The home is part of a small group of homes owned by the registered providers. Care Homes for Older People Page 4 of 29 2 9 0 5 2 0 0 9 73 0 Over 65 0 73 Brief description of the care home The home provides nursing care for 23 older people whose needs are due to physical frailty, and fifty people who have dementia. The home has 65 single bedrooms, 26 of which have en-suite facilities, and four bedrooms, which may be shared by two people. Externally the gardens are landscaped and are secure. Car parking facilities are provided at the home. All rooms and areas, including the gardens, are spacious and are accessible to wheelchair users. Fees range from four hundred and sixty-six pounds to six hundred and seventy-five pounds per week. Information about the home can be obtained by contacting the care home manger directly. Care Homes for Older People Page 5 of 29 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: We carried out an unannounced visit to the Willows on 11 May 2010 and followed this with a planned visit on 12 May 2010. The visits lasted ten hours and were done by one inspector. The report will say we when referring to what was done and found at the visit, as it is written on behalf of the Care Quality Commission. The visit was just one part of the inspection. Before the visit the manager was asked to complete a questionnaire to provide up to date information about the home. We sent out questionnaires to people who live in the home, relatives and the staff team to find out their views about the Willows. Other information about the home was also reviewed. During our visit we looked at various records and the premises. We looked at the care records of five people who live in the home, to see how their needs were being met. We also looked at three staff files to ensure that thorough recruitment processes had Care Homes for Older People Page 6 of 29 taken place and that people who live in the home were safeguarded from harm and supported safely. We spoke with some of the people who live at the Willows, the manager, one of the owners and staff who were on duty at the time of the visit. They all gave their views about the home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 29 Most of the requirements and recommendations made at the previous inspection visit have been met. Outstanding requirements and recommendations have been remade in this report. The information gathered about the needs of the people who are going to move in has been improved and more detailed information is available, so that people are confident that their needs have been assessed and can be met by the home. Improvements have been made in the care plans; these are now well written and good information is available. Systems for supporting people to walk safely have been improved and the way peoples decisions are reflected within the care plans has been developed and incorporated into the plans of care. The way that controlled drugs are recorded has improved so that people who live in the home can be sure that medicines are recorded appropriately and in a safe manner. Training on safeguarding adults has been undertaken by all the staff so that they are aware of what abuse is and what to do to make sure that people living in the home are protected from harm. What they could do better: Two requirements were made; the manager of the home must apply for registration with the Care Quality Commission, so that the home is run by an suitably competent and qualified person and staff must have mandatory training so that people who live in the home are cared for by suitably trained staff. Several recommendations were made and areas for improvement included, updating the statement of purpose and service users guide to ensure that accurate information is available to people and other formats of these documents should continue to be developed so that a range of formats are available in line with individual peoples needs. Care plans should be developed in a person-centred way so that the information they contained is written from the individuals perspective. Also development of the recording of activities should be considered so that significant information is captured and used to develop suitable activities for each individual person. Specialist training, formal supervisions, annual appraisals and staff meetings all need to be brought up to date so that people who live at the home are supported by a staff team that is well trained and supported by the management of the home. Relative support meetings and surveys to the people who live at the home, relatives and other professionals should be undertaken so that peoples views of the home can be documented and used in the future planning of the service. Areas where people who live at the home, relatives and staff thought improvements could be made included: the laundry; more observation and attentiveness from staff to clients; some staff not showing respect or care for clients; and staff training and supervision. Other comments included: some bedrooms could do with refurbishment and better communication is needed between the care staff and kitchen staff regarding Care Homes for Older People Page 9 of 29 dietary requirements of new residents. 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 10 of 29 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 11 of 29 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 receive good information about the home for them to make an informed decision about moving in and their needs are checked before they move in so they know that these can be met at the Willows. Evidence: We saw a copy of the information that tells people how the home works (the statement of purpose and service users guide). These had been updated in April 2010. The service users guide used large print and was written in plain English. It contained the mission statement, information about the home, bedrooms, the provider and manager and the complaints procedure. The statement of purpose also contained this information as well as information about the staff, admissions policy, fire precautions, facilities and services, decor and furniture, medical and personal care, arranged health services, hair dressing, laundry, advocacy and administration support. It also included information on gifts and signing legal documents, pets, religious provision, residents property, celebrations, entertainment and activities and shopping. Both these Care Homes for Older People Page 12 of 29 Evidence: documents need minor amendments to them to bring the information up to date and a recommendation was made regarding this. The manager has started to look at other formats for these documents, but they hadnt been produced as yet and the manager confirmed she was looking at large print and possible production in other languages. A document was available for staff to use with people before they move into the home to check on what their needs are. This covers personal information, next of kin, GP, personal care and physical well being, communication, mobility/dexterity, personal safety and risks assessments, continence, diet and weight, food and mealtimes, dental and foot care, daily living and social activities, religious observances, medical history medication, mental health and cognition. These are signed and dated by the assessor. Other information is sometimes available regarding a prospective resident and this can include a hospital discharge summary, social service assessment or NHS continuing health care assessment. If available, the manager would use this information as well as the other checks to decide if the persons needs could be met at the Willows. The home has two beds which it uses for intermediate care. This is where people move into the Willows for shorter periods to be supported to help them return to their own home after their convalescence period ends. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at the Willows are met by the staff in a way that enables them to maintain their privacy and dignity. Evidence: We looked at the care plans of five people who live at the Willows, to check the care they receive. These had been improved; they were well written and the language used was clear. However, they were not written in a person-centred way and this needs to be developed to ensure that the individual person is put first in the plans. We saw that acknowledgement to privacy and dignity was mentioned in some of the care plans. Each file contained details that had been obtained when the person moved in, including relevant personal details, care plans, daily records and risk assessments. There were also details about visits from health care professionals to check on peoples health care needs. The daily records were completed for each person and contained information about their well-being and the activities they had taken part in during the day. These were signed by the staff on duty. All the files had care plan reviews in place to make sure these were up to date and still Care Homes for Older People Page 14 of 29 Evidence: effective. Some of the people were not able to confirm that they had been involved in planning or reviewing their own care; however, they were able to confirm that staff helped them when they needed it such as with personal care tasks. Risk assessments were included in the care plans. These were up to date and had been carried out for pressure ulcer prevention, nutritional assessment, resident handling, mobility, mobility aids, bedrails and falls. These help to make sure that people are not put at risk, that any risks are minimised and people remain safe. The medication for people living in the home is stored in each unit. There are three medication trolleys within the two units and these are stored securely when not in use. A monitored dosage blister pack system is used at the home, supplied by the local chemist. The two medication rooms also had storage space for extra medications and a fridge for medication that needed to be kept chilled. The controlled drugs book was checked against supplies and all were found to be correct. The controlled drug storage, administration and procedures were found to be satisfactory. The nurses organised the ordering and disposal of medication. They also administer all the medication within the home and had undertaken medication management training. Staff were observed giving out medication during this visit. Staff took each persons medication to them with a drink of water or juice. They stayed with the person until they were sure the medication had been swallowed. These measures help to make sure that people living at the home receive their medication as prescribed. Care Homes for Older People Page 15 of 29 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. Social activities are well managed so people living at the Willows have daily variation and interest in their activities. People are provided with a variety of home cooked food, which they enjoy. Evidence: There is an activities organiser employed at the home. He had an activities file and kept a record of what activities each person living at the home had taken part in. This helped to show the range of activities each person had undertaken and to plan for future activities that people would enjoy. Activities included catch ball, manicures, walks in the garden, bowls, drawing and colouring, crafts, dominoes, painting, one to one time, memory cards, bingo, playing cards, jigsaws and quizzes. The activities coordinator was also bringing his dog into the Willows for animal therapy; the residents told us they enjoyed having the dog in the home and sometimes went on walks with him. Future plans included trips out on river boats and a choral evening at Chester Cathedral. The activities organiser had developed this role and he was going out and about in the local community with residents. Some information about social activities and families was written in the care plans and some in the activities sheets. Information about Care Homes for Older People Page 16 of 29 Evidence: families and their names and significant dates, birthdays and anniversarys could be recorded and used in further activity work with each person. This could be recorded on the current system or possibly look to developing a diary for each person. A monthly religious service is held in the home by the local vicar and choir from the Church of England church. The priest from the local Roman Catholic church visits to give communion to those who want it each Friday. The manager confirmed that they had good contacts with the local community, that the local school visited periodically and the home had been asked to be involved in the local Blacon Festival. The home had a four week menu that was being reviewed by the chef at the time of our visit. Different meals were being tried and feedback sought from residents with a view to developing the range of meals available on the menu. The chef said that mainly fresh foods were being used, including fresh vegetables and fruit. This had been a change in the home as before frozen vegetables were mainly used. The chef confirmed that the food suppliers were good and the quality of food was high. He was working on promoting a better and varied menu and a higher standard of catering, to improve standards overall. The kitchen was seen to be clean and tidy during this visit and the chef said that the kitchen assistants completed most of the cleaning within the kitchen. Fridge, freezer and hot food temperatures were recorded to show that food was being stored at the correct temperature. It was noted that when others were covering for the chef that these records were not always completed and it was suggested that training be given to the other staff so they knew these needed to be recorded. Various types of meals are provided including diabetic and soft diets. Small portions are given when people requested them. The chef commented that the nurse in charge knew her group of residents well and could tell him what was needed at meal times. Residents meal choices are gathered by the staff in the morning for the evening meal and lunch next day. We saw that people had appropriate coverings to protect their clothes during the mealtimes and that there were enough staff around to support people during mealtimes. Care Homes for Older People Page 17 of 29 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 homes procedures for complaints and safeguarding are effective so that the concerns of people who live at the Willows are listened to and they are protected from abuse or harm. Evidence: We looked at staff files during our visit and these showed that staff had completed training about safeguarding adults, which showed us that the requirement about this we made at our last inspection had been met. The manager confirmed this and showed that she was aware of the policy, procedure and guidance on safeguarding. There were policies available in the home on adult protection (safeguarding), harassment, anti-bullying and whistle blowing. The training and policies helped make sure that staff would know what to do to protect people living at the Willows from abuse. The home had made five referrals to the Independent Safeguarding Authority and details about these were kept at the home. The complaints procedure for the Willows was satisfactory and contained details of how to contact us but needed to be brought up to date. The home has a complaints file and had one complaint over the last year before our visit. This complaint was being investigated and information about this was seen during our visit. Good records were kept. The commission had not received any complaints about the Willows over the last year before this visit. Care Homes for Older People Page 18 of 29 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 Willows is well maintained and furnished to a good standard so the people who live there do so in safe, comfortable surroundings. Evidence: During our visit we walked round the building and saw all the shared (communal) areas as well as a number of bedrooms. The standard of decor and furnishings was good. The home was clean and free from unpleasant odours. People who live at the Willows had made their bedrooms more homely using ornaments, pictures and photographs that they had brought with them when they moved in. The home was warm and well lit. The garden was secure so that people who live at the Willows could walk around it in safety. Access to the garden for people was good. The Willows had a wide range of communal areas available to the people living there, including a variety of lounges, dining areas, quiet rooms and a conservatory that is used for activities. Within the dementia care unit the walls of the corridors are painted in prominent colours to promote different moods such as calming and appetite promotion. Doors that residents dont need to use are painted in the same colour as the walls. Other doors such as toilets and bathrooms are painted yellow so that they stand out and are easily recognised. The atmosphere around the home was calm and there appeared to Care Homes for Older People Page 19 of 29 Evidence: be enough staff on duty to meet the needs of the people living there. On the wall near to the dining areas there was a white board which showed the day, date, staff on duty, the menu for the day and the weather. This was used to help people know which staff are around and what the meals were for the day. There is an ongoing programme of renewal within the home which includes decorating and refurbishment. Over the six months before our visit redecoration of the corridors, some lounges, dining rooms, the reception area and ten bedrooms had been undertaken. As bedrooms become vacant they are redecorated and have new carpets and furnishings as required. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are thorough recruitment processes used to make sure that staff are suitable to work with the people living at the Willows and they have received training but some of this needs to be updated to make sure that the care being given is safe . Evidence: The staff rotas showed the number of staff on duty over the week. Three nurses were on duty during the day and they were supported by seven care staff. The care staff team are supported by the chef, kitchen assistant, housekeepers, laundry assistant, maintenance support, activities co-ordinator and administration support. People who live at the Willows confirmed that there were enough staff around to help them and during this visit we saw that staff were attentive to peoples needs. We checked three staff files and they all had the necessary pre-employment checks in place including identity checks, Criminal Record Bureau checks, Protection of Vulnerable Adults first checks (now called Independent Safeguarding Authority [ISA] Adult First checks), references and completed application forms. These checks are carried out to make sure that staff are suitable to work with people who live at the Willows. All the staff had received mandatory training in moving and handling, fire safety awareness and safeguarding adults. However, other mandatory training such as health Care Homes for Older People Page 21 of 29 Evidence: and safety, infection control, food hygiene and medication awareness was not up to date. Some staff had completed some of this training but from the records available this was difficult to determine. Some specialist training had been completed. However again this was difficult to determine due to inadequate records. Courses undertaken included continence awareness, oral health, Deprivation of Liberty awareness, diabetes awareness, management of medication and depression. Also some of this training had been undertaken several years ago (some dating back to 2006) and refresher training would be beneficial. It is also strongly suggested that training for all staff in dementia care is undertaken. Progress has been made with National Vocational Qualification (NVQ) training. Fifteen out of twenty-eight staff have achieved NVQ level 2 or above or have a nursing qualification, and four staff are currently working towards this award. This means that a good percentage of the staff team have a nationally recognised qualification in social care. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Willows had policies and procedures in place to ensure the health and safety of the people living there are promoted and protected. Some improvement needs to continue to the quality assurance systems to make sure the home is running in the best interests of the people who live there. Evidence: At the time of our visit, the home manager had worked for the company that runs the Willows since 2003 and had been the manager of the home since 1 June 2009. She is a RMN with a great deal of experience of working with clients who have dementia or mental health needs. She is also an NVQ Assessor and has undertaken specialist dementia training. At the time of our visit, she was gathering the paperwork needed to submit her application for registration with the commission once her Criminal Records Bureau disclosure has been obtained. We had previously made a requirement for her to apply to be registered with the commission and this remained outstanding at this visit. Care Homes for Older People Page 23 of 29 Evidence: The information we were sent before our visit gave a good overview of what had happened at the home during the twelve months before this inspection. The manager told us that, they promote and maintain a welcoming, informal , family-like and friendly atmosphere within the home and that they adhere to standards and regulations and the companys mission statement. That over the last year they have established realistic aims and objectives and that they continually look for better working practices. There is a quality assurance process for the home which includes staff meetings, relatives support group meetings, a quality assurance self assessment process and surveys to people living in the home, their relatives and professionals involved in their care. A representative from the company visits the home each month to check on how it is running. The most recent visit before this inspection was on 22 April 2010 and the report of the visit covered meetings with people who live in the home and staff team, inspection of premises and a selection of records. Good records were kept of these visits and no areas of concern noted at the last visit. The home was using a quality assurance self assessment called Putting Service Users First. This pack provided a range of surveys to be used with residents, relatives and professionals involved in the care of people living at the home. At the time of our visit, the manager had distributed the new clients survey to people who had moved into the home recently and expected to have feedback by the end of June 2010. It was recommended that an analysis of the feedback be produced and shared with all interested parties and the commission. The manager confirmed that over the few months following our visit, she would be sending out surveys to people living at the home, relatives and others involved in the care provided at the home. It was suggested that these be developed and completed on an annual basis to ensure that peoples views about the home are obtained regularly to help in planning future developments and improvements at the Willows. Before our visit, there had been a staff meeting for trained staff in February 2010 and a full staff meeting in June 2009. There were minutes kept of both meetings. No other recent meetings had taken place for the ancillary staff or for the full staff team to help keep them informed of developments/improvements and to obtain their views about the running of the home. Relative support meetings had been undertaken in the past, but no records were kept as these were informal meetings. These are facilitated by the senior care staff and were an opportunity for relatives and staff to discuss any issues raised. It was Care Homes for Older People Page 24 of 29 Evidence: recommended that these be restarted and that notes are kept to show issues raised and progress made. The home had produced a business plan for 2010 known as Willows Aims and Objectives 2010. This document set out clearly what they were hoping to achieve during the year and was being monitored monthly by a representative of the organisation that runs the home to show the progress being made. Day to day supervision of the staff team was good but records we saw showed that no formal supervision had been undertaken since April 2009. This type of supervision provides staff with a chance to discuss their personal development and care practice with managers as well as providing them with guidance and support. Annual appraisals were also overdue, as the records we saw showed these were last done in December 2008. Some of the people who live at the home have asked the home to look after small amounts of money on their behalf. This is stored securely in the home and the records and arrangements we saw for peoples personal allowances were satisfactory. We saw a wide range of the homes policies and procedures at this visit. Files containing these were kept in the office and they were also available on the computer. This meant that they were easily available for staff to consult for guidance. The policy on gifts stated that staff did not accept gifts or become a beneficiary of a residents will. This information was also seen in the statement of purpose. The smoking policy stated that no smoking was allowed inside the building, but that staff can smoke outside in the designated area. This information was also seen in the staff handbook. Safe working practices were in place in the home. There were up to date safety checks on the homes electrical wiring system and gas installation. All checks with regard to the fire safety systems were up to date and checks were also completed on the emergency lights, fire extinguishers and controlled waste. The accident report file was seen and all records were appropriate. The manager completed a quarterly audit of falls and accidents and was working with the local GP to reduce the number of falls of people who live at the Willows. It was noted that the number of unwitnessed falls had decreased over the last few months before our visit. Policies relating to safe working included moving and handling, infection control, food and nutrition, food hygiene, health and safety, risk assessment, accident and incident reporting, fire safety and mobility. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 31 8 An application for the manager to become registered with the Care Quality Commission, as required by law, must be made. This is so that we and the people that live and work at Willows will be confident the home is run in their best interest. 09/09/2009 Care Homes for Older People Page 26 of 29 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 30 18 Staff must regularly attend mandatory training and/or updates and this should be recorded. This is to make sure that people who live in the home are supported by well trained staff who can provide care in line with current good practice. 31/08/2010 2 31 8 The manager must apply to be registered with the commission. This is so that the manager who is registered with the commission in accordance with the law. 31/07/2010 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 1 The statement of purpose and service users guide should Page 27 of 29 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 be reviewed and minor changes made to include updating the details about the commission and information about the manager, so that people have access to up to date information about the home. 2 1 Continued consideration should be given to producing the statement of purpose and service user guide in other formats that are suitable for the people living in the home so that they have access to information in a format that they understand. Care plans should be written in a person-centred ways that puts the individual person first so that it reflects their views, preferences and needs. Information gathered regarding families and significant dates should be kept in a record so that this information can be used to develop peoples social activities and contact. Staff should have access to a range of specialist training, in line with the needs of the people living at the Willows, so that the staff are well trained to support the people living at the home. Relative support meetings should be reinstated and records should be kept to show what was discussed and how it was dealt with so that people feel that their views are taken into account. The surveys being sent to new residents should be analysed and the outcome shared with all interested parties and the commission. Surveys for people living at the home, relatives and other professionals should be distributed and information received analysed and shared with all interested parties and the commission. This will help to make sure that the people who live at the home can express their views about it and influence future developments there. Regular staff meetings should take place for all staff so that they have the opportunity to contribute to the running of the home. Staff should have regular formal supervision sessions and annual appraisals so that they have the opportunity to discuss their work and future training needs with their manager. 3 7 4 12 5 30 6 33 7 33 8 33 9 36 Care Homes for Older People Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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