Key inspection report - cqc.org.uk · CV1 3GB The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency

Inspecting for better lives

Key inspection report

Care homes for older people

Name: The Willows

Address: 38 Westminster Road EarlsdonCoventryWest MidlandsCV1 3GB

The quality rating for this care home is: one star adequate 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: Date:

Sandra Wade 2 5 0 2 2 0 0 9

Care Homes for Older People Page 2 of 37

This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better.We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service.

After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.

Outcome area (for example Choice of home)

These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them:

This box tells you the outcomes that we will always inspect against when we do a key inspection.

This box tells you any additional outcomes that we may inspect against when we do a key inspection.

This is what people staying in this care home experience:

Judgement:

This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor.

Evidence:

This box describes the information we used to come to our judgement.

Copies of the National Minimum Standards – Care Homes for 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.

http://www.tso.co.uk/bookshop


Reader Information

Document Purpose Inspection report

Author CSCI

Audience General public

Further copies from 0870 240 7535 (telephone order line)

Copyright 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.

Internet address www.cqc.org.uk


Information about the care home

Name of care home: The Willows

Address: 38 Westminster RoadEarlsdonCoventryWest MidlandsCV1 3GB

Telephone number: 02476220161

Fax number: 02476550126

Email address: [email protected]

Provider web address:

Name of registered provider(s): Willows Care Home Ltd

Type of registration: care home

Number of places registered: 32

Conditions of registration:

Category(ies) : Number of places (if applicable):

Under 65 Over 65

old age, not falling within any other category

0 32

Additional conditions:

Date of last inspection

Brief description of the care home

The Willows is a residential home for thirty-two older people. The home is located in the Earlsdon area of Coventry, close to the city centre, and is readily accessible to amenities such as shops, places of worship and public transport.The home is located on three floors, with the upper floors easily accessed by a passenger lift. The accommodation consists of thirty-two single bedrooms, six of which have en-suite facilities. There are also two lounges on the ground floor, eight toilets, two assisted bathrooms, two assisted shower rooms, kitchen, conservatory/ dining area and administration office. There is also a basement, which is used as a staff room and for storage.The home has gardens to the rear of the establishment and also has around six car parking spaces for visitors.Fees are detailed in the Service User Guide for the home and at the time of the inspection the manager advised ranged from 376.50 pounds to 442.00 pounds per week. There is a detailed list also of additional charges that apply over and above


Brief description of the care homethese fees. This includes charges for staff escorts on some trips but not all, meals for guests, hairdressing, clothes labelling, chiropody, lost room keys, electrical portable appliance testing, electricity for any oxygen equipment, charges for larger personal jobs over half an hour by maintenance engineer, newspapers, toiletries, TV licenses for rooms, items you damage other than normal wear and tear, insurance cover for valuables, private telephone installation, external entertainment and outings and alcoholic drinks.


SummaryThis is an overview of what we found during the inspection.

The quality rating for this care home is: one star adequate service

Our judgement for each outcome:

Choice of home

Health and personal care

Daily life and social activities

Complaints and protection

Environment

Staffing

Management and administration

peterchart

Poor Adequate Good Excellent

How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 12 February 2008. This inspection took place between 8.20am and 8.00pm. Two people who were staying at the home were case tracked but specific care issues

relating to other residents were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection detailing information about the care and services provided. Questionnaires were also sent out to residents within the home to ascertain their views of the service. Information contained within the AQAA has been included within this report as appropriate. Details from surveys has not been included as residents were assisted by a member of staff at the home and these therefore do not represent an independent view. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge/dining areas to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home.


What the care home does well:

Staff were observed to be friendly and approachable towards residents. Relatives stated in questionnaires completed for the home that staff were helpful. There is a relaxed atmosphere in the home with residents interacting with one another and staff. There is a programme of social activities and events that take place which includes sing a longs, physical fun, bingo, word games and puzzles, church service, art and crafts and outside entertainers. Residents enjoy the home cooked food and special diets are catered for such as a vegetarian option and soft diet if required. Staff training is provided on an ongoing basis to ensure staff have the skills required to meet the needs of the residents. Staff recruitment is managed well to ensure those employed have all the necessary checks and are deemed safe to work with the residents. The home environment is clean and well maintained with two lounge areas and a sitting area in the dining room. Each has pleasant furnishings to make this homely for the residents.

What has improved since the last inspection?

The garden area has been improved and new garden furniture purchased at the request of residents so they can sit out in finer weather. Residents have been able to go out on more outside trips that have been organised by the home. Some improvements have been made in regard to how medication is managed. This includes the provision of an air conditioning unit to keep the storage of medications at their recommended temperatures prior to administration and improved storage of controlled drugs. Records of money spent by residents are now accessible by the home should they be requested. A call bell lead has been extended in one of the residents rooms that was identified at the last inspection to be too short for them to reach. Some improvements have been made in regard to quality monitoring systems which have incorporated obtaining views of relatives.

What they could do better:

All prospective residents should have an assessment of their needs prior to admission to ensure their needs are fully identified and staff are clear whether they can be met.


Care plans need to be kept uptodate to ensure staff know what support is needed to meet the care needs of the residents. Risk Assessments need to be reviewed to ensure they contain suitable actions to manage the risks to residents effectively and safely. This includes both management of nutrition, skin deterioration and residents with challenging behaviour. A review of medication is required to ensure this is managed appropriately to maintain the health of the residents. Call bell leads need to accessible to all residents in their bedrooms and a review of access to call bells in communal lounges is also required so that residents can alert staff if needed. Resident choices need to be maintained. This includes the provision of menus with full choices of meals, drinks and snacks so that they know what is available to them. The systems for managing allegations of abuse and the protection of the residents need to be improved to safeguard residents. Staffing arrangements for the home need to be reviewed to ensure they are effective at all times to meet the needs of residents. Receipts need to be maintained for money transactions carried out for residents to ensure the home can demonstrate their money is being managed appropriately. The process for obtaining the views of residents should be managed in a way that ensures they can give their views independently with the help of an advocate if needed as opposed to staff being involved in this process. Some health and safety checks need to be confirmed or followed up to demonstrate the home is safe for residents. This in particular applies to electrical checks and wheelchairs. Systems for monitoring the ongoing management of the home need to be reviewed to ensure they are effective at all times and the care of residents is not compromised.

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 [email protected] or by telephoning our order line –0870 240 7535.


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


Choice of home


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.


Judgement:

People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

Prospective residents have access to detailed information about the home to help them make a decision on whether to stay. The needs of residents have not always been assessed prior to their admission to ensure these can be met by the home.

Evidence:

There is a Service User Guide that gives information about the care and services available but the copy viewed did not contain a summary of our inspection report as required. It was evident that spare copies of our inspection report were available in the reception of the home for visitors to view or take away. A visitor spoken to said they were given sufficient information about the home prior to their relative being admitted. Three people who use the service were case tracked. One person who had arrived from overseas had no pre-assessment of their needs prior to admission and staff had therefore relied on information provided by a friend. This resulted in staff not having a


Evidence:

full picture of the residents needs upon their admission to ensure they could meet them. A second resident had been admitted from another home within the organisation, this person also did not have a pre-assessment completed upon their admission. Care records in place were therefore not accurate in regards to the current needs of this resident to ensure staff could support them effectively. A new manager has recently been appointed to the home and she was able to confirm that these matters had been identified. She stated that a review of all care records was in the process of being undertaken to ensure the care of residents could be met effectively.


Health and personal care


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.


Judgement:


Care plans are not up-to-date for all residents and this has impacted on their care needs being met consistently. Some actions are required to ensure medication is managed effectively to support the health care needs of the residents.

Evidence:

Two residents were case tracked and the records of one resident who had been taken to hospital were also reviewed. This resident had been taken to hospital as a result of a fall. The manager was able to advise this person had a sore to their heels, parkinsons disease and diabetes. Staff spoken to were able to explain how the parkinsons disease presented itself and how this affected the resident. On viewing the care records it was clear that the information detailed was out of date. This person had not been assessed prior to their admission so there was no recent information on file for staff to develop a care plan from. Staff therefore had built up their knowledge of the resident over a two month period since the person had been admitted to the home.


Evidence:

Care records stated that the resident needed one carer to assist when being bathed or hoisted. The manager confirmed this should have read two staff. The records also stated that the resident was fully mobile with the aid of a trolley. Staff confirmed that this was not the case and not accurate. If information on care plans is not accurate the safety of the resident could be compromised as well as their needs not met. It was not evident that appropriate care plans had been developed for the management of pressure sores (where skin develops sores from prolonged pressure) to ensure staff managed this appropriately. The same also applied to care plans around weight and nutrition. Where there had been a significant weight loss or history of poor nutrition there was no consistent approach taken to managing this. Risk assessments and food intake monitoring had not been consistently completed to demonstrate the risks of malnutrition had been identified and to show suitable actions were being taken to address this. Many of the records viewed were not dated so it was not clear when the care needs had developed. The 'Client Diary' which staff use to record support given on a daily basis was not always sufficiently detailed to gain a picture of the residents current independence and health. For one person with poor mobility there were minimal references to how this was being supported. A resident with diabetes did not have a care plan showing the symptoms to look out for if their blood sugar should be too high or too low and what staff should do in these circumstances. It was evident that staff had weighed the resident and their weight had increased from January to February demonstrating their food intake had been sufficient. It was not evident that any care plan reviews had been completed for one resident to ensure information detailed was up-to-date. The inspector observed one resident to be seated in their room for much of the day. Prior to lunch an apron had been put on the resident. They were observed to eat independently but slowly. Later in the afternoon the resident was seen having a drink and was still in the same apron. The drink was in a large spouted beaker and fairly full which they struggled to hold straight. The apron that the resident was wearing was covered in food debris and was very wet suggesting during the afternoon they had spilled their food and drink onto it. This was mentioned to the manager to address. Another resident seated in the lounge was noted to have food stains on their slipper and clothes although they were suitably dressed and their hair combed.


Evidence:

The manager acknowledged that there were shortfalls around care planning which had impacted on the residents. She advised that as a result of this, she had been reviewing all care plans to ensure they were suitable and appropriate. She confirmed that this process was not complete and there were still some to do. Staff spoken to said that due to increased number of residents with high dependency they had found it difficult to manage the needs of all residents effectively. This included keeping up-to-date with the changing needs of residents. It was noted during the inspection that staff do not use the care plans on a daily basis when recording information in the daily diary. This can prevent staff from keeping up-to-date with residents and their needs. A review of medication was undertaken. The manager advised that she now books in the medication with another member of staff to ensure all medication has been received as appropriate. Medication is stored in suitable trolleys in a medication room. Since the last inspection an air conditioning unit has been purchased to ensure medications are stored at the correct temperature. Although the majority of medications seen were being managed appropriately there were some areas of management that are in need of improvement. On one Medication Administration Record (MAR) the code "N" had been used to indicate "offered PRN but not required". The medication in question had not been prescribed "PRN" Which means "as required", it had been prescribed at certain times by the GP and therefore should have been managed in this way. There were several gaps noted over three MAR charts viewed where no signatures or codes had been used to say if the medication had or had not been given. On one MAR the code "G" had been used which should have been defined on the back of the chart but this was blank so it was not clear how this medication had been managed. Some of the medication when counting the amount received, given and remaining did not add up. This was the case in regards to paracetamol, Quetiapine and Aspirin. Some of the medications received had not been documented as received on the MAR chart so it was difficult to check that the amount received, given and remaining was correct. Some of the instructions on the boxes and bottles of medication had not been recorded on the MAR with the same wording. This is important to help prevent staff error when administering medication. Systems for storing controlled drugs were found to be appropriate and records were


Evidence:

accurate in regards to those given. There were no concerns regarding the privacy and dignity of the residents during this inspection.


Daily life and social activities


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.


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 provided to help maintain the wellbeing of the residents. Residents are able to exercise some choice in regards to care and services provided to maintain their independence and they enjoy the meals provided.

Evidence:

Social activities are provided which are confirmed in a social activity book and diary. The book lists activities including crafts, quizzes, hairdresser, baking, beauty afternoon, reminiscence and moving to music. The 'Annual Quality Assurance Assessment' (AQAA) provided by the home also details social activities provided. These include sing songs, physical fun, carpet bowls, arts and crafts, church visits, word games and puzzles. An outside trip was made to the Blooms Garden Centre and a pub lunch was also arranged. The 'Activity Book' also shows a visit to Hatton Country World. There is no specific Activity Organiser employed by the home but carers aim to complete social activities with residents on a daily basis. The 'Activity Diary' confirms activities that have actually taken place and on viewing the diary many of the above were confirmed to have taken place. During the morning of the inspection a carer went around to the residents to ask if


Evidence:

they wanted to play Bingo and this took place in one of the lounges. Nine residents in all took part and seemed to enjoy this. In the other lounge a film was put on, "My Fair Lady" this did run into lunch time and after lunch the film was started again from the beginning. The film was also still running at the end of the day. One resident spoken to was asked if they enjoyed the film and they said they were "fed up" with watching "My Fair Lady" because it had already been played several times over Christmas. Several residents received newspapers and were reading them. It was noted that in the dining room sitting area the lighting was not working making it very dim for one resident to read their newspaper. Visitors were seen to come and go during the day demonstrating open visiting times. The sitting area in the dining room was well occupied and residents were observed to enjoy interacting with the staff as they walked past. The cook took the time to have a conversation with one resident who clearly enjoyed this that they asked her again later if she could sit down and have a chat. There were periods during the day when residents sat quietly or were asleep. One resident who said they go to bed early was asked why and said it was because they "got bored" in the evenings. The provider has subsequently stated that the home did try providing social activities in the evenings but it didnt work well because residents wanted to go to bed. The AQAA provided by the home acknowledges that the home need to monitor outings and activities to make sure they "get it right" for residents. Individual care plans indicated resident choices as well as likes and dislikes. One for example said the resident liked roast dinners, sweets and crisps another said the resident like muesli and bananas for breakfast. It was evident that roast dinners were being provided but not the muesli and bananas. The cook was not aware of this specific request. The manager advised that the care plan for this resident was not up-to-date. Other care plans gave indications of those residents who liked to choose their own clothes to wear and whether they preferred a bath or shower. It was noted that there is no printed menu showing the choices of meals, drinks and snacks available to residents. The copy kept by the Cook showed that there is no cooked breakfast on the menu. The Cook said that the residents do not eat their


Evidence:

dinner if they have one but she did provide a cooked breakfast at the weekend if they wanted one. To enable residents to have the choice, cooked items should be available on the menu. One resident said that they occasionally had a cooked breakfast. Another resident had requested a bacon sandwich but it was recorded in their records that staff had responded to say there was none. The Cook said she always has bacon in the fridge and there was packet in the outside fridge seen. Daily menus are written on the blackboard outside the dining room. Two residents spoken to said they were looking forward to dinner which was roast beef, when asked if they were both having this and they said they were not aware there was a second choice. The cook confirmed that on Wednesdays and Sundays they always have just one main meal option which is a "Roast". The cook explained that on Wednesdays the food ordering had to be done. The Cook said there is also a vegetarian option that can be made available. The main meal looked appetising and portions were of a generous size. Residents seemed to enjoy their meal. A member of staff was seen to sit with one resident to support them to eat. This was done sensitively and without rushing them. The desert was fruit salad and icecream and it was noted that this was given out with both already in the dish. Residents were not asked if they wanted both. One person said they had eaten the fruit but they didnt want the ice cream. Another resident took one spoonful of the fruit salad and said they didnt like it. The option to have just ice cream or fruit should have been given to ensure this promotes the residents choice. The dining room is spacious and attractive with tables that seat four people. There are suitable comfortable dining chairs with casters on the bottom for ease which dont 'run away' when sitting on them. The dining area was observed to be clean and pleasantly presented with table decorations and condiments on each of the tables. At mealtimes there is also sugar and milk on the tables. There were sufficient stocks of both dried, tinned and fresh food produce available in the home.


Complaints and protection


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.


Judgement:


Policies and procedures are in place to manage concerns and complaints but these have not been followed consistently to ensure the protection of the residents is maintained.

Evidence:

There have been no complaints received by us since the last inspection. There has been one complaint received by the home from a resident who was not happy with the care and services provided. It was evident from records in place that this had been fully investigated and the complainant responded to. An easy to understand complaints procedure is available and is displayed within the home so it is readily available to residents, staff and visitors. This contains all relevant contact names, addresses and telephone numbers. The exception to this is only our address was printed and not our name and telephone number, this was pointed out to the manager. The Service User Guide that is given out to residents did however contain all information and it states within the guide that this can be provided in large print or tape if the resident requires. Staff are aware of the complaints procedure and know to report any concerns to the manager. The "Elder Abuse" policy and procedure for the home was viewed. This was not specific in naming contacts and telephone numbers. The manager said that there is


Evidence:

a procedure available with this information but this could not be located on the day of inspection. Training records in place confirm almost all staff have completed regular training on the protection of vulnerable adults and staff knew to report any concerns to the manager or provider in her absence. Since the last inspection there have been some concerns around how the protection of residents has been managed. One resident had left the home on numerous occasions without staff noticing initially. Although on each occasion the resident was found and returned, it was not evident that the home had taken appropriate steps to make a safeguarding referral. This would have helped to ensure appropriate measures were taken to prevent this happening after the first time. A risk assessment had been developed stating that the resident liked to exit the building and acknowleding that there was a safety implication but it was clear the actions identified to help prevent this were not effective in managing the risk. Staff spoken to said that at the time this person was in the home they had a lot of dependent residents who needed their attention. They found it difficult to constantly monitor this resident and provide the support required with also having to support others. They stated they had reported their concerns to the manager. The manager concerned has since left the home and the resident concerned has also moved to another home. The Acting Manager gave assurances that changes in practice have been implemented to ensure this does not happen again. This includes closely monitoring the dependency of residents both upon admission and during their stay to ensure they are appropriately placed and staff can support their needs. The provider has also subsequently confirmed that swift action was taken following concerns reported by staff in regards to the increased dependency of the residents. This had resulted in some residents being reassessed and some moving on to more appropriate placements. Another resident received incorrect medication over a 14 day period due to a staff error that was not identified. The GP had been contacted when this was discovered and no harm had come to the resident. It transpired that this error was made due to the homes policies and procedures not being followed when medications are booked in. The Acting Manager has now taken actions to ensure this procedure is followed. It was established from discussions with residents and staff that the heating in the home had not been working effectively for a period of time and in particular in the


Evidence:

dining room and some bedrooms. A resident who had been in the home for a period of respite care had complained about the heating not working. This is something which could impact on the health of the residents and was not reported to us as required. It was evident that portable heaters were available in the home and some were seen in the dining room. The provider advised that these heaters had been provided to the home in the event of any problem with the heating system and that staff have always has access to these should there be any problems. Staff reported at the inspection that the heating has since been fixed.


Environment


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.


Judgement:

People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service.

The home offers comfortable and well maintained indoor and outdoor accommodation for the residents.

Evidence:

A tour of the building was undertaken. The home is pleasantly decorated, homely and is accessible to wheelchairs. There is a lift which can access all floors and a ramp which leads from the dining room into the attractive gardens to the back of the home. Since the last inspection trees in the garden have been removed and new garden furniture purchased at the request of the residents. On the day of inspection the home was found to be clean and tidy and there were no unpleasant odours with the exception of one room seen. It was found that in this room the commode had been used and not emptied. The two lounges in the home are pleasantly decorated and both were used by residents during the inspection. There is also a seating section in the dining room which residents can use as a quiet area if they wish. It was noted that access to call bells in the communal areas is restricted and some residents raised concerns they cannot always alert staff when they need them.


Evidence:

The downstairs corridor and dining room areas have attractive wood panelled flooring and the lounges have carpets. Bedrooms viewed were carpeted and pleasantly decorated and had been personalised with photographs and various other personal items to make them homely. In one room the call bell lead had to be stretched across the room and only just reached the bed of the resident. When not in use this is rolled up and left on the bedside. The call bell leads need to be sufficiently long enough to reach the bed without being a trip hazard. This issue was raised at the last inspection in regards to another resident and although this was addressed, it was not evident all call bell leads have been checked. In one room there was no call bell lead at all. There are sufficient bathrooms and toilets in the home to support the needs of residents and the baths have chairs to assist the less able when getting into the bath. The laundry room although small contains two washing machines and two driers to support the laundry needs of the home. There were baskets available to sort dirty and clean washing and gloves and aprons to maintain good infection control practices. Staff explained that laundry arrives in linen bags and is sorted into these baskets. There is a person allocated to do the laundry but this person also works in the kitchen. This is not ideal as the laundry is classed as a "dirty" area and the kitchen a "clean" area. The provider has subsequently confirmed that the member of staff concerned always changes gloves and aprons before working in the kitchen and that they only work in the washing up area of the kitchen and not near food preparation.


Staffing


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.


Judgement:


There are sufficient numbers of trained staff to support the needs of the residents most of the time. Suitable recruitment systems are in place to ensure staff are checked and deemed safe to work with the residents.

Evidence:

Staff employed at the home were observed to be caring, friendly and supportive towards residents. A relative survey carried out by the home shows that nine out of nine relatives who responded felt that staff were helpful. Two had commented that the home has "excellent" staff and nine have stated they feel that the care that is provided is "satisfactory". It was evident that there have been periods of time when staffing has not been effective due to the increased dependency of the residents. Since the last inspection a manager had been appointed but has recently left before they could become registered with us. On the day of inspection a new person was in post who advised that they were working in an 'acting manager' role. They were aware that should they be accepted to take on this role permanently they would need to make an application to register with us .


Evidence:

On the day of inspection there were 28 people in the home. The manager advised that they aim to have five staff on duty during the morning, two of these working from 7.30am until 1pm and three from 8am to 1.30pm. From 1.30 to 4pm three care staff and from 4pm to 9pm four care staff. At night two waking night staff. In addition to care staff the home also has specific staff to undertake cooking, cleaning, laundry, maintenance and administration work. Duty rotas were obtained for the four weeks prior to the inspection to confirm staffing numbers. These showed that over a two week period there were four care staff working most mornings and not five and for one week there are four staff not three working in the evening. It was noted that duty rotas did not detail the full the names of staff to provide an effective audit trail, this matter was raised at the last inspection. Duty rotas also showed that there were agency staff being used on most days with several shifts being covered each day. A member of staff said that more agency staff were being used due to some staff leaving. The manager said that they had a vacancy for one full time member of care staff and two part time staff and they were hoping to bring the use of agency staff down once these posts had been recruited to. Staff spoken to said that they had found it difficult in recent months to dedicate the time they would like to all residents due to the increased needs of some residents in the home. It was established that staff morale had been low and staff had felt their concerns were not effectively addressed by the previous manager in post. One member of staff said that most of the residents needed two staff to support them and in the evening this was a particular problem. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to this inspection shows that 13 care staff have left the home in the last 12 months. Staff meeting notes show that the previous manager had increased the staffing in the evening to cope with the extra demands on staff and staff had commented that they had found this much better. Current duty rotas however show that the evening numbers have been reverted to three staff. The provider has subsequently confirmed that the staffing numbers have recently reduced in the evenings due to some of the residents with high dependency moving on to more appropriate placements reducing the need for the extra member of staff. During the inspection it was noted that around tea time staff were busy and they did not realise that there were residents in one of the lounges who needed to speak to them to make a request. These residents were unable to alert staff as there was no call bell accessible to them. These residents said that in the afternoons the staff were


Evidence:

"too busy" to attend to them. One said "all I want to do is get a cup of tea and go to my room and go to bed". It was pointed out to the resident that it was only 5pm but they insisted they still wanted to go to their room and read a book. Both residents said staff were more accessible in the mornings because they were giving out medications and they saw staff during the tea rounds. Staff training is provided on an ongoing basis. A staff list provided during the inspection shows there are eleven care staff (including the deputy) employed by the home. The training schedule shows that there are five of these staff with a national vocational qualification (NVQ) II or III in Care and one person who is currently "in progress" to complete this which meets the 50% required by the care standards. A training schedule for the home confirms that staff have also undertaken other training including moving and handling, food hygiene, infection control fire health and safety and dementia awareness. Some of the moving and handling training was detailed as needing renewal for some staff in three years and others one year. It was not clear from the training schedule if this was due a different type of training being provided. Basic moving and handling training for care staff should be updated on a regular basis. The fire training for some staff was up-to-date but for others it was not. Some staff were due to update their training in August 2008 and it was not clear this had been completed. A review of staff files was undertaken to confirm that recruitment practices are being carried out as required to safeguard residents. It was found that all of the necessary checks had been undertaken including Protection of Vulnerable Adult (POVA) First checks and Criminal Record Bureau (CRB) checks prior to their employment. Detailed induction records were available for new staff employed. It was evident that the induction training provided is in line with the 'Skills for Care Council' common induction standards. This training enables staff to build up their competencies in a number of areas over a period of weeks so that they can provide safe and appropriate care to the residents.


Management and administration


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.


Judgement:


The management of the home has not been effective consistently to support the health, wellbeing, safety and independence of the residents.

Evidence:

Since the last inspection the manager for the home has left. The provider had however appointed a 'acting manager' to support the home and they were present during this inspection. The acting manager has managed the home before for approximatley 4 years and prior to this worked as a care assistant in the home. She has a wealth of experience in caring for older people. At the time of this inspection she had been in post for several weeks. We sent questionnaires out to the home prior to the inspection for residents to complete but it was evident they had been assisted by a member of staff to complete them meaning they did not give an independent view. Responses have therefore not been included within this report.


Evidence:

The home had carried out their own quality questionnaires with relatives of residents and positive responses had been received with nine out of nine responses stating the care given is satisfactory and eight out of nine feeling management are approachable. Comments made included "good food", "home is nice and clean", "excellent staff" and "very satisfied". The more negative responses were "some rooms have odours" and "some food hard to chew". In terms of monitoring the quality of service with residents in the home, it was not evident they had been sent surveys asking them about all aspects of care and services provided. Systems for monitoring their views of the service include staff interviewing some of the residents each month and they can complete one of the surveys available in the reception of the home if they choose to. Residents had however completed a survey about social activities and these were discussed during a residents meeting held in March 2008. Seven felt there were enough activities but did not join in. The reason they gave is because it was "too cold". The meeting notes state that the heating is in process of being repaired and they will look at having a new heater. During the inspection residents were complimentary of the staff in terms of their friendliness. Staff were observed to be approachable and supportive of residents when they asked staff for help. There were however some residents who felt they were not getting as much support as they would like and this is explained in the staffing section of this report. The provider has undertaken monthly visits to the home to speak to residents and staff and inspect the premises. Reports seen showed that those residents spoken to are "happy", "feel staff look after them well" and feel staff "respect their privacy". These reports also identify that some incidents in the home had not been reported to us and some care plans have not been updated. The report states that an action plan has been put in place and is being implemented in regards to these. The manager confirmed during the inspection that as part of this action plan, all care plans were to be reviewed by the end of February 2009. At the time of the inspection on 25 February 09 there were still ten care plans to review. Since the last inspection there have been a number of incidents that have happened in the home that have not been managed well. This includes, ensuring suitable assessments of residents are carried out prior to their admission to ensure the needs of residents admitted can be met. Due to this not happening there have been residents admitted to the home requiring increased staff support which has not been managed


Evidence:

effectively. This resulted in one resident leaving the premises on several occasions initially unnoticed placing the resident at risk. In addition there have been residents with challenging behaviour and residents needing two staff to support them which staff communicated they had found difficult to manage. There have also been medication errors and an incident concerning the management of money which have all impacted on the effective running of the home. These incidents had occurred prior to the new manager being in post but she was aware of these incidents and an acknowledgement was given that there are improvements that need to be made. The manager was both open and cooperative during the inspection and it was clear there is a commitment to raise the standards in the home. Staff spoken to were complimentary of the new manager and commented that staff morale was already improving. In regards to the management of residents money. The home operates a system, which is called a 'Sundry Extras Charge'. This is a scheme, which is free of any administration charge to residents but involves the resident calculating in advance how much money they are likely to need each month. The resident or their representative then pays this amount by standing order to an account managed by group accountant within the organisation. Records of the transactions carried out by each resident can be accessed by the home but at the time of this inspection receipts were not available to confirm that these transactions had taken place. The inspector was advised that any receipts are forwarded to the Group Accountant who keeps detailed records of these transactions. Copies of receipts must be available to residents and their representatives within the premises as proof of the transactions undertaken. The home keep an amount of petty cash to allow for any immediate payments needed for residents. The Service User Guide (SUG) states that statements can be provided upon request to the Group Accountant or at the end of each residents stay. The process for making this request is not clear. The SUG also states that the organisation may increase or reduce the charge to reflect changes in the requirements of the resident. The SUG does not make it clear that this will be agreed with the resident or their allocated representative prior to this happening. Details of the 'Sundry Extras Charge' are explained in the Service User Guide booklet. Anyone not joining the scheme would be expected to handle their own finances. Appropriate security systems are in place for the storage of residents money. A review of health and safety checks was undertaken. There is a detailed fire risk assessment in place which is being updated following fire safety checks carried out during the year.


Evidence:

The electrical wiring certificate stated it was a "Domestic Installation Certificate" and that it was completed by a "Domestic Installer" as opposed to this being "Commercial" as required. This will need to be followed up as appropriate. It was evident that the passenger lift had been recently serviced and that a legionella water check had been done in June 2008. Hot water temperatures were being checked on a two monthly basis in resident areas and all those recorded were within the recommended guidelines so as not to scald a resident. The records for the electrical portable appliance testing could not be located to confirm these had been undertaken. The manager agreed to forward these once located. The gas record confirmed this had been checked in April 2008. Some of the wheelchairs in the home were observed to move even when the brakes were on when residents were being transferred. This is not safe and was discussed with manager with a view to wheelchairs being appropriately serviced. Call bell leads were not easily accessible in communal areas and in some bedrooms to ensure residents who are not mobile can alert staff they need assistance.


Are there any outstanding requirements from the last inspection?

Yes £ No R

Outstanding statutory requirementsThese are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.No. Standard Regulation Requirement Timescale for

action


Requirements and recommendations from this inspection:

Immediate requirements:These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.No. Standard Regulation 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 3 14 Residents must be assessed prior to their admission to the home to identify their needs. This is to ensure staff can confirm they can effectively meet the needs of the resident.

31/03/2009

2 7 12 The care needs of residents must be met consistently. Care records must be kept up-to-date to support staff in meeting the needs of the residents. This is to ensure the health and wellbeing of the resident is maintained appropriately.

31/03/2009

3 8 14 Nutritional Risk Assessments need to be sufficiently detailed to ensure effective actions are taken to address risks identified. This is to ensure risks to residents health are appropriately managed.

31/03/2009


4 9 13 Medication must be regularly audited to confirm the correct amount has been received, given and remains. This is to ensure any errors are identified promptly to prevent this impacting on the resident.

31/03/2009

5 9 13 The correct codes must be used on medication records. This is so that it is clear how the medication has been managed.

31/03/2009

6 9 13 Prescribing instructions on bottles and boxes of medication must be accurately reflected on the MARs. This is to ensure residents receive the medication as prescribed without potential error. This is an outstanding issue.

31/03/2009

7 9 13 MARs must be completed consistently with no gaps so that is it clear how medication has been managed. This is so it is clear whether a resident has or has not received their medication to maintain their health.

31/03/2009

8 18 13 The protection of residents must be managed effectively. Safeguarding procedures must be followed as appropriate.

31/03/2009


This is to ensure residents do not come to harm and are managed safely within the home.

9 22 23 An assessment of how call bells can be made accessible to residents in a safe manner is to be undertaken. This is to include an action plan stating actions to be carried out. This is to ensure residents can summon the help of staff when they need to.

30/04/2009

10 31 12 The management of the home must be effective at all times. Appropriate and effective monitoring systems need to be in place to ensure this. This is to ensure the protection of the residents and ensure their needs are met consistently.

30/04/2009

11 38 13 Equipment used by residents must be appropriately maintained to ensure it is safe to use. This includes wheelchairs. This is to ensure residents are cared for safely and do not come to harm.

31/03/2009

RecommendationsThese 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 It is recommended that a summary inspection report is included within the Service User Guide to demonstrate this is being given out consistently to prospective residents to help them in making a decision on whether to stay at the home.

2 7 It is recommended that staff use the care plans each day to keep up-to-date with residents changing needs and to ensure daily diary entries are focused on the care needs identified.

3 12 It is advised that a review of social activities and entertainment is reviewed in line with residents choices. This should include the option of social activities or entertainment in the evenings.

4 14 Cooked items should be made available to residents at breakfast time to promote choice, these should be demonstrated on the menus available to them.

5 14 It is advised that menus are made available to residents detailing all meals, snacks and drinks that are provided. This is so they know what choices are available to them each day.

6 16 All complaints procedures available in the home should contain our name and telephone number to ensure this is accessible to people who may want to contact us.

7 26 Commodes in use need to be regularly checked to ensure they are emptied and washed and the environment is kept clean and pleasant for the resident.

8 33 There should be a clear quality monitoring system which targets all residents in the home and allows them to give their views independently or with the help of their representative as opposed to with staff at the home. Residents should be given the option to respond anonymously.

9 35 Receipts in regards to transactions made by residents must be maintained in the home to demonstrate the money received and spent by residents is as stated on records.

10 38 It is recommended that hot water checks are completed monthly as opposed to bi monthly so that any malfunction with thermostatic mixing values which may alter the temperature of the water can be identified and actioned swiftly to prevent any scald risk to residents.

11 38 Electrical checks for the home need to be carried out appropriately. Confirmation is needed that a commercial electrical wiring check has been carried out within the last 5 years and that all electrical portable appliances have recently been tested as required.


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Documents

Key inspection report - cqc.org.uk · CV1 3GB The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency