The Care Quality Commission
  • Care Home
  • Care home

Archived: The Villa

Park Avenue, Maddocks, Madeley, Telford, Shropshire, TF7 5AE (01952) 581022

Provided and run by:
Mr Douglas Juru & Mrs Susan Juru

All Inspections

15 July 2014

During a routine inspection

The inspection was completed by a single adult social care inspector. On the day of the inspection the service was provided to 31 people. As part of this inspection we spoke with six people who used the service and one relative. We spoke with the registered manager and five members of staff. We also reviewed records relating to the management of the home, staff rosters and training records. We sampled four care plans. We observed staff interact with people.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Care plans had been developed. They identified people's needs and were reviewed regularly. Staff demonstrated a good understanding of people's needs. People were given choices and supported to make decisions themselves. Risk assessments were in place for things such as moving and handling, safety in bed and showering. Control measures had been put in place. This meant that people's needs were met and people were kept safe. People we spoke with told us they felt safe. A relative said, 'Yes, x is very safe here.'

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Documented procedures were in place for The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw records of DoLS application that had been authorised. As a result of new guidance issued by the courts an advisor was due to visit the home to help them identify any further DoLS applications that need to be made. This meant that systems were in place to safeguard people as required.

Staff had received training in The Mental Capacity Act 2005. We saw mental capacity assessments and any subsequent best interest decisions that had been made. Records identified when people lacked capacity to make their own decisions. This meant that systems were in place to safeguard people as required.

The service was safe, clean and hygienic. Some people we spoke with were able to confirm their rooms were cleaned daily. We found areas of the home in need of re-decoration. We saw that cleaning schedules and checklists had usually been completed. Vacant rooms were deep cleaned. This meant that the provider took action to maintain a clean hygienic environment and reduce the risk of spread of infection.

The registered manager set the four weekly staff rotas. They take into people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. Staff told us that there were always plenty of staff on duty. This helps to ensure that people's needs are always met.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care and support that met their needs. People told us how they were supported. This was in line with their care plans. The registered manager told us they worked with other agencies to ensure people's health and social care needs were met. A relative confirmed that the people receiving care and support were involved in decisions about their care. This meant that people received care in the way they wanted.

Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people's needs.

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with told us how they supported people. People confirmed staff were caring. We saw that staff were polite, respectful and considerate towards people. They demonstrated patience and reassured people. One person said, 'The staff are very good.'

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. Church services regularly took place at the home. This meant people's diversity and individuality were promoted and respected.

Is the service responsive?

We saw records that showed the service responded quickly to meet people's needs and ensured people's safety and dignity was maintained. For example, call bells were answered quickly and staff let people into the front garden when they requested it. People confirmed that they were given choices and encouraged to express their views.

People told us they would speak to the registered manager if they had a complaint. A relative said, 'I have no complaints.'

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. All staff felt supported in their roles and felt their views were listened to. Staff we spoke with told us there had been a lot of improvements.

The service had a quality assurance system. A number of audits were regularly undertaken. The registered manager told us that action would be taken as a result of findings. This meant the quality of the service was able to continually improve.

2 September 2013

During a routine inspection

Most people we met were not able to describe their experience of the service they received in great detail. One person told us, 'I come and go as I please' and, 'The food is ok most of the time.' We were also told by one person that they had always been involved in the planning of their own care.

The staff had received training in dignity in care and we observed staff treating people with dignity and respect.

We saw that care plans were person centred, comprehensive and up to date. People's needs were individually assessed. Their care and treatment was planned and delivered in line with their individual needs.

We found that medicines were generally safely stored, handled and administered. Medicine records were accurate and doctors' instructions were properly acted upon. However, we found that one person had recently been given a medicine shortly after its expiry date.

We found that staff had all received training in the safeguarding of vulnerable adults. We saw that that there was a safeguarding risk assessment on each person's care plan to help keep them safe from harm.

The home had been without a permanent manager for several months. Staff we spoke with told us that they had been fairly well supported in the absence of a full time manager but they were looking forward to the stability that a new manager would bring.

27 November 2012

During a routine inspection

There were 25 people living at the home on the day of the inspection. We spoke with 10 people who lived at The Villa and one visitor. We also spoke with the manager, eight staff and a representative of the management company employed by the provider.

People were satisfied with the care they received at The Villa. One person said, "They are looking after me very well".

Care plans recorded people's needs and included risk assessments when necessary.

People were provided with a range of nutritious food that met their dietary requirements.

People were protected from the risk of abuse because staff were trained to recognise and report any concerns.

Medicines were stored and administered appropriately.

The Villa provided an adequate environment that had improved since a redecorating programme had started.

Staff were formally supervised and their performance monitored. They had access to relevant training.

Records were stored securely. They were dated, signed and fully completed.

6 August 2012

During an inspection looking at part of the service

We visited the home unannounced on the 6 August 2012 to check if the home had complied with the warning notice we issued on the 27 June 2012. The warning notice related to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2012 (the Regulated Activities Regulations 2012) which covers the home's responsibility to ensure that people receive effective and safe care.

We spoke with the manager, six staff, representatives of the management company who are involved in running the home and eight people who used the service. We looked at five care files.

People we spoke with told us that they were satisfied with the level of care provided by the home. Two relatives had written to the home telling them that they were satisfied with the service provided by The Villa.

Staff engagement with people had improved and staff paid more attention to individuals than on previous visits.

Care files were better organised and contained updated care plans and risk assessments.

Staff were more confident and knowledgeable about people's care and support needs than during previous visits.

The home had failed to follow their own procedure on two occasions when a vulnerable person had left the home.

29 May 2012

During an inspection looking at part of the service

We visited the home to check on the outstanding compliance actions which were issued in January 2012 and April 2012.

There were 26 people living in the home on the day of the visit. We spoke to six people, four staff, the manager and the provider. We looked at selected care plans, staff files and other records related to the running of the home.

We carried out a telephone survey of three relatives so we could include their views about the service provided at The Villa. This was carried out after the visit.

We observed that interaction between staff and people who live at The Villa had improved since the last visit. We saw that staff spoke to people now and listened to them when they needed or wanted attention.

There had been some improvements in the care files but these remained chaotic and difficult to use. Care records did not clearly identify people's needs and give clear guidance and advice for staff on how to meet these. Care records were not all up to date and reflective of people's current needs.

There had been improvements in the way that food and drinks were provided since the last visit. People were more likely to be offered fresh fruit, condiments, drinks and snacks. A lack of training and reference material means that knowledge about how to meet people's dietary needs was still limited.

There had been some improvements in relation to the way infection control issues were managed but some areas of the home's practice still means that people are not safe from the risk of infection. Some areas of the home smelt unpleasant and some areas smelt strongly of cat urine.

Although improvements were observed in the management of medicines, the service was still not fully protecting people against the risks associated with medicines.

A programme of redecoration and refurbishment had been started since the last visit. However, because of a lack of long term investment and on going maintenance, many areas of the home remain shabby.

We saw that a training programme was in place and some training had been undertaken since the last visit. We also saw that there was a lack of specialist training available to staff so that they could acquire the necessary skills and knowledge to meet people's needs.

We found that although there had been some improvements since the last visit there were still not adequate systems in place to monitor the quality of the care provision in the home to ensure that it was run in the best interest of people who live there.

We have noted the introduction of an updated list of people's needs on care plans. However the quality of care records was still poor with many of the care records still out of date and not containing identified needs or clear guidance for staff on how to meet these. Care records were not being regularly evaluated to see if the plan was effective and working. Staff supervision records were incomplete and not used to evaluate staff performance.

7 March 2012

During an inspection looking at part of the service

We undertook this visit to see if the home had addressed the non compliance with outcome 4, care and welfare that were identified during the visit that took place in October 2011.

We spoke to seven people who live at The Villa, the manager and three members of staff.We looked at care records, medication records and other records relating to the running of the home.There were 28 people living in the home on the day of the visit.

People told us that the home was 'all right' and that they felt generally looked after by staff. Some people told us that they were still being woken up earlier than they would choose to get up.

An activity programme was displayed with two people taking part in gardening on the day of the visit. Some people would like more activities available that they could join in with, particularly those who are not mobile.

We found that people using the service did not always receive good care. We saw that the dignity of people living in the home was not promoted. Whilst we saw increased interaction with people by some staff we also observed some staff ignoring people when they were talking or when they were asking questions of staff such as requesting drinks or information.

The quality of record keeping was poor with the majority of care records out of date, badly written and not reflective of people's current needs and circumstances. Care plans and risk assessments were not routinely reviewed when circumstances changed for example after people had fallen. Records were not detailed enough or tailored to individual needs to make sure that people's health and welfare was monitored and maintained.

There were no management systems in place to make sure that people's care and welfare needs were met or that staff were following the homes policies and procedures in relation to record keeping.

The knowledge and understanding of the management of medicines by the nursing staff was poor. The health and welfare of people using the service was not protected as the home had failed to ensure that the staff were competent to manage medicines safely. The home did not carry out effective audits to identify problems with the administration of medicines to people using the service. The home did not have an effective quality assurance programme in place to ensure the safety of the people using the service.

20 October 2011

During an inspection in response to concerns

We received concerns from different sources prior to our visit. The concerns related to lack of choice given to people using the service, poor practice by staff and poor environment.

We carried out a telephone survey of the supporters and family of seven of these individuals so we could include their comments about their impressions of the care and support the people they visited experienced. Our survey was carried out after our visit.

We visited at 7:30am. One inspector stayed in the lounge area for about four and half hours and watched the care provided to people using the service as well as staff interactions.

We saw that people were not always involved in decision making and were not always consulted about the care they received.

We found that several people were already up in the lounge when we arrived. Some people told us they were not given a choice and would have preferred to stay in bed.

We saw that several people appeared unkempt and a bad odour came from the lounge. We did not see any person in the lounge being offered assistance to bath, wash or shower.

We found that people using the service did not receive good care. We saw several examples of bad practice including poor moving and handling techniques which could put people using the service at risk of harm or injury.

We saw that the dignity and privacy of people living in the home was not always promoted. People's requests were ignored for example we saw some people using the service ask for drinks and did not receive them. We saw staff handing biscuits to people using the service rather than allow them to choose what they wished to eat. We saw that hot drinks were served without saucers or teaspoons.

Concerns were raised about the quality of the food provided at the home and the lack of fresh fruit or vegetables. We found a lack of fresh fruit when we visited and one person told us that the portions were small.

People told us the home was not clean and was shabby in places. Our findings also confirmed this. Several parts of the home had an unpleasant odour of stale urine. Bathrooms and toilets people were expected to use were soiled and in need of a thorough clean. As a result of our inspection we informed Mrs Juru the registered manager that we were going to contact the environmental health and infection control professionals about our concerns.

We found that there were inadequate systems in place to monitor the quality of care provision within the home to ensure that the home was run in the best interests of people who live there. We found that records were not kept detailed enough to ensure that people's health and welfare was monitored and maintained.

As a result of our observations we sent an alert to the local safeguarding authority, where we shared our comments about the care of three people we observed to receive.

When we contacted people who visit the home as part of our telephone survey at the end of October and beginning of November we received a variety of comments from people. Some people expressed the same issues we found during our visit when we went to the home on 20 October. Other people expressed their satisfaction with the care the home provided, and condition of the accommodation the home offered.

Visitors told us that when important things happened the communication between them and the home was good.

People we spoke to also informed us that standards at the home had begun to improve since we visited, and people were starting to enjoy a better lifestyle.

Following our visit we met with the registered provider and discussed our findings in detail. Assurances were given on the action to be taken to make sure that people living in the home receive the care they need.