Inspection on 15/07/09 for Holmbury Dene

This is the latest available inspection report for this service, carried out on 15th July 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmbury Dene 08/10/07

Holmbury Dene 18/05/06

Holmbury Dene 08/12/05

Holmbury Dene 29/04/05

Holmbury Dene 22/12/04

Holmbury Dene 02/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Holmbury Dene 2 Lawrie Park Road Sydenham London SE26 6DN Lead Inspector Lynne Field Key Unannounced Inspection 15th July 2009 09:30 Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmbury Dene Address 2 Lawrie Park Road Sydenham London SE26 6DN 0208 7787700 0208 7789437 holmburydene@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) PLUS (Providence & Linc United Services) None Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 8th August 2008 Date of last inspection Brief Description of the Service: Holmbury Dene is a very flexible service that has 54 service users who use the service on a needs lead basis over the course of a year. This means service users are able to stay for as short or as long a period of time as is agreed and / or needed either by them or their carers. It provides care for up to 10 people with learning disabilities at any one time. Three of the ten service users in residence may have a physical disability as well as a learning disability and or challenging behaviour. The support offered includes mental health and management of challenging needs. The home is staffed on a 24-hour basis, consisting of a manager, an assistant manager and full and part time support workers. Staff levels can vary depending on the number of service users staying at the home at any one time and the level of their support needs. The home provides respite care for service users who live in the community with carers and for service users awaiting a more permanent placement. The home is also the emergency placement and assessment centre for people with learning disabilities in Lewisham. It is a large, two and a half storey building close to Sydenham train station and local shops and services. The area is also well serviced by buses to central and south London. There is accessible off road car parking space for up to seven cars to the front and side of the building. The garden is accessible from the dining room. The ground floor is wheelchair accessible consisting of four single bedrooms, a reasonably sized kitchen, a dining room, a large lounge looking Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 5 onto the front of the building, one fully accessible shower room/toilet, one fully accessible bathroom and the staff sleepover room. The first floor contains three single bedrooms, two bathrooms /toilets, a lounge area and the staff room. There is also a self-contained flat on the first floor currently not used for accommodation. The second floor has a room that had been used for volunteers but was now vacant. The service is block funded by Lewisham Partnership and so information is not available with regards to monthly fees. Prospective service users are given information about the service via a Service User/Carer pack. The range of fees is charged from £1179-92 per week. Additional charges are made for things such as hairdressing and toiletries. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and was carried out over two days in July 2009. The first day of the inspection was spent at the organisations head office checking staff files. We were able to view three staff files relating to the home and found they had all the information relating to good recruitment practices and spoke to the human resources manager. The deputy manager facilitated the second day of the inspection at the home. The service manager was at the home at the time of the inspection and we were able to speak to her about the service and how it was developing. We checked records on care plans, medication records and the complaints book and were able to access confidential documents. We checked three of the staff files that are kept in the home and saw copies of training records. There was evidence of regular supervision taking place and we were told staff meetings are held at least every two months or more regularly in necessary. The deputy manager completed a copy of the Annual Quality Assurance Audit document which provided us with information about the service. This was taken into consideration and used as part of the inspection process. We were able to speak to six staff during the course of the inspection including three new members of staff who confirmed they had induction training and had been supported during their induction period. We spoke to one member of staff who had been with the service for over twenty years and said they noticed things were changing in the home and how the service was delivered. We were given a tour of the premises and were able to check records relating to the health and safety aspects of the service. Service users came and went during the inspection and we were able to meet six and speak to four service users. Staff interaction with the service users was good and service users said they felt supported by the staff at the home and were listened to. What the service does well: This continues to be a very busy service that offers much needed respite for families who live in the community. The new deputy manager and new staff have settled into working in the service well. The team continues to manage any challenging behaviour of the residents well. There is a good understanding of how to defuse potentially volatile situation while treating the service users with respect and dignity. The service is very flexible and manages to keep up with the changes that occur in the service users lives well. The needs of service users are fully assessed prior to being admitted to the home. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 7 The service promotes independence for service users who have a range of disabilities and continues to offer good individualised specialist care for service users who need high levels of support. Service users who stay at the home for longer periods are supported to get involved in training/educational courses and to find employment. They also engage in a variety of leisure activities and generally to become part of and participate in the local community attending local day centres, going to restaurants, the cinema and using other local facilities such as the library and shops. Service users are supported to maintain links with family members and other appropriate personal relationships. Visitors are made to feel welcomed by staff. Staff make sure service users individual food preferences and specific cultural needs are catered for and encourage them to eat a healthy diet. The service continues to address the health and personal support needs of service users well with input from a range of different health professionals such as GPs, district nurses, mental health teams, speech therapists amongst others. What has improved since the last inspection? What they could do better: Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 8 Care plans need to be more comprehensive and contain more information about the needs of the service users as well as reflecting what has been agreed in reviews and from speaking to service users. Care needs to be taken when dispensing medication and correct procedures followed at all times. Service users should be encouraged to develop their daily living skills by being supported to self medicate. Service user meetings need to be reinstated to allow service users to air their views and any concerns they may have in a structured way. 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. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents’ needs and aspirations are assessed, so that a service tailored to their needs could be provided. EVIDENCE: We saw the statement of purpose and the service user guide, which includes the complaints procedure. The service user guide gives information about the fees charged by Lewisham Social Services who have a block contract with the organisation. Service users stays are paid for by Lewisham Social Services who then invoice the service user or their family. The service user guide has been produced in an accessible format for residents using “Widget” picture graphics. The deputy manager said a full needs assessment would be carried out based on the personal history and the core assessment completed by social services to make sure they can provide the right type of service for potential service users before a place at the service was offered. There is a risk assessment meeting which involves the service user, their carer, social worker, staff from the home and other relevant professionals, is held as part of the assessment Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 11 possess and care plan development. There was evidence of the assessments on service user’s files we checked. We were told potential service users and/or their carers / representatives are invited to visit the home to look at the house. This gives them the opportunity to find out more about the service that is being offered. They are given a “Welcome Pack” that includes a service user information form that is used to gather information about the service user for the care plan folder and a carers’ agreement. As part of the assessment the deputy manager might also visit the service user at their day centre to speak to them about their needs and what they hope to get out of the service. There are staggered visits to suit the service user where the service user is invited to the house for lunch or tea visits to meet other service users and staff. If the tea visits go well, there is a planned over night stay followed by a two night stay. Service user plans demonstrate that specialist services such as mental health services, specialist behavioural services, speech and language therapy, district nurses amongst others are accessed to ensure service user’s needs are met. We were told the home organises staffing so service users new to the service have identified staff working with them each time they use the service. There are regular discussions about new referrals in team meeting. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 People using the 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 service users are involved in planning their care with their key worker, the registered manager, appropriate professionals and family members. Service user’s files, including care plans and risk assessments need to be audited to ensure there is enough information in them to enable staff to support service users in the way they want their care delivered. Potential risks are identified and residents are supported to take risks within a risk management framework. EVIDENCE: Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 13 We checked five service user’s files that we case tracked. Two were of new service users who had recently started to use the service and two had used the service for some time and one was for the service user who lived at the home permanently. Service users’ care manager allocates a number of days the service user is able to use the service for based on a needs led basis. This takes into consideration the needs of the service user and the needs of their carer. This means some service users could come in regularly each week/ month, while others may use the service very infrequently. As at the last inspection, it was identified that service user plans were based on information from the core assessments obtained from the local authority. They contained a lot of detailed information about the personal, health and social care needs of individual service users and included interventions and individualised procedures to address aggressive and other forms of challenging behaviour. This is to ensure that the changing needs and personal goals of service users are clearly reflected on service user’s files. When we checked the files we found there was not as much information as there could be. There were support plans in place but again information held needs to be more detailed and information kept up to date. Some had no profile or photo and a number of documents within the files wee not signed by either the service user or their carer. Some had up to date risk assessments. The management of the home has recently changed with both the registered manager and the deputy manager leaving in the last few months and much of the paper work and files needs to be reviewed and audited. As there are 60 service users who use the service, this is a large undertaking and time consuming. The new manager starts work at the home in the middle of August and much of the service and systems would be reviewed then. We saw some copies of six monthly review meetings on the files inspected and were told the service is conducting its own internal reviews. The deputy manager said they would include family and professionals in reviews and would ask them to sign care plans and support guidelines to indicate their involvement where possible. If the service user has not used the service for a number of months and the care plan is due to be reviewed, staff need to contact the parent/carer to ensure the service known about any changes that might have taken place since the last visit and this is recorded on the care plan or medication chart. We were told although the home was mainly to be used for respite care lately they have had service users who have needed interim care. This has meant other service users have not been able to use the respite care service because places have been taken by longer stay service users, which is not ideal. As noted at previous inspections the local authority carries out reviews every six months. Service users, family members and key workers are invited to attend but these are generally held at the day centres or the main council offices. We have been told they try to attend these meetings and will rota staff on to go to represent the home but sometimes at the last minute something prevents staff attending. As stated in previous inspection reports, it is important for staff to attend because as part of service users’ overall care, the home needs to ensure they are kept informed of the needs of service users Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 14 and any changes. It is an opportunity for the service to up date the family and professionals about how the service user is progressing. There were copies of best interest meetings that had been held and on the day of the inspection one service user was in the process of having their care assessed and having a best interest meeting. The home has a key worker system. There was evidence that support workers had been allocated to work with individual service users and also that the role of the key worker and responsibilities involved have been discussed with staff as part of a team meeting. Service users are offered opportunities to participate in the day-to-day running of the home. They are supported by staff to make decisions about what they wanted to do for the day. Service users are encouraged to help around the house and supported to do their laundry. Service users are encouraged to go into the kitchen to make drinks and meals for themselves with the support of staff if necessary. Service user meetings have ceased in recent months so service users are not able to discuss as a group any concerns they may have or be given information about what is happening in the home. Service users need to feel included, listened to and valued. Service users meetings need to be reinstated. Risk assessments are developed from the assessments and with service user involvement and these are reviewed at risk assessment meetings. The service user, their carer, social worker, staff from the home and other relevant professionals where possible are involved in reviewing the risks. Part of the services policy is that all staff have to sign that they had read the details of the risk assessment. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16,17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to take part in age, peer and culturally appropriate activities and are being given opportunities for personal development. Service users are supported to participate in the local community. The home supports and encourages service users to have appropriate personal and family relationships. A healthy diet is provided, which the service users enjoy. EVIDENCE: Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 16 We checked five files service users files and saw evident that service users are offered specialist interventions and opportunities by trained staff to help facilitate their personal development in respect to emotional and communication needs. We saw staff encouraging service users to develop independent living skills by supporting them to assist in daily tasks around the home. We met seven of the service users who were living in the home at the time of the inspection and spoke to four. We were told there is key-working system in place for those on interim placement. One service user had lived in the home since it opened over twenty years ago. They said they liked living there. They said they were involved with the recruitment of staff and were paid to do this. They said staff helped them to keep in touch with relatives and friends. We were told there were daily discussions with all service users living in the home about any issues or plans they have that day. Some are organised by the day centres where some service users attend. All service users have individual activity plans in place that detail all the activities that service users engage in during the week. These demonstrate that service users are engaging in appropriate leisure activities. There was also evidence from the daily logs that service users are engaged in other activities. We met four service users who had returned to the home after a day at various activates in the community. One service user we spoke to earlier in the day was going out to their place of work. They were there on an interim placement and said they enjoyed living in the home but would like their own flat. They said they were helped by the deputy manager and staff. We checked copies of daily records of the service users. These are kept by the staff who have worked with the service user on that day. We saw staff completing these at the end of the shift. The home supports and encourages service users to maintain family links and friendships inside and outside the home. One service user told us about their family and when they went to visit them. This was recorded in their file. Some service user regularly go out on their own and come and go as they wish but they need to let the staff know when they will be returning. This is recorded in their care plans and agreed with the home and their social worker and is risk assessed. There are procedures in place the home follows if the service user does not return when they say they will. This has happened a number of times and the home keeps all relevant professionals, including the police, informed and of the outcome. The home does not have a planned weekly menu. Instead, individual service users are asked what they would like to eat for lunch and supper and this is then prepared. As there is a turn over of service users with individuals needs staying at the home, sometimes for short periods on respite, this arrangement does ensure that personal preferences are catered for and specific cultural needs are also met. A record of all meals eaten by service users is kept as part of their individual daily log. A sample of these was checked and there was Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 17 evident service users are provided with a good variety of meals that were nutritious and balanced. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support, in the way they prefer and their physical and emotional needs are met. The homes medication policies and procedures on the handling and administration of medication need to be followed at all times. EVIDENCE: Information collected at the pre admission assessment and during the homes assessment of the service user goes towards developing the care plans, which involves the service user and their carer. All five care plans viewed during the inspection contained some information and guidelines on all aspects of personal support and care required by service users including personal preferences around personal care, eating and drinking preferences, individual communication needs, mobility needs and managing behaviour presented by Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 19 service users. Some had more comprehensive information than others. See Standard 6. It was clearly evident from speaking to the service users and checking the daily logs that service users physical and emotional needs are being well met with regular liaison with a range of healthcare professionals including mental health teams, physiotherapists, G.P’s, speech therapists, district nurses, dentists, chiropodists amongst others. Some of the care plans we checked needed to contain more detailed information about how service users liked to have things done. See Standard 6. Appointments relating to service users health needs are recorded on a Medical Report form. In addition in relation to service users individual health needs there was evidence of monitoring of pressure areas, fluid intake and an epilepsy monitoring form. At the last inspection we were told interim service users are offered an annual health check and they hope to extend this to include all service users who use the respite service. The home has a robust medication policy and procedure. There are individual procedures in place that have been agreed with individual relatives and carers, but all medication should be checked and counted before the relative leaves the home. If there are any discrepancies or changes to the medication this can be discussed and the mar chart amended. We were told that only permanent staff administer medication and that they have all received training from the local pharmacist. None of the service users living at the home at the time of the inspection were administering their own medication. We asked why one service user who seemed very capable is not self medicating. The service user could be trained and risk assessed to do this. Staff said when a service user came to stay all their medication was checked, counted and recorded on the MAR chart. It has to be in the original correctly labelled container other wise they would be unable to give it until they had checked with the GP or family carer. A stock check is done each night. We checked four service users medication and found discrepancies in the records, which indicated the medication had been wrongly administered. The member of staff who checked this with us reported this to the deputy manager. Medication must be correctly administered at all times and staff need to follow the correct procedures to do this. Both staff and the registered manager said the local pharmacist came to a team meeting to do refresher training with them. The homes medication procedure and practice is checked on a regular basis by the local community pharmacist team. The registered manager told us that homes managers carry out internal spot checks of the medication each week. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People using the 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 has a robust complaints procedure, which is also in an accessible format for service users. There are comprehensive adult protection procedures and a whistle blowing policy in place to ensure service users are protected from abuse. CQC have been informed immediately when incidents occur. EVIDENCE: The service has a robust complaints procedure that includes the stages of, and the timescales for the process. This is also in a format accessible to service users with “Widget” picture graphics being used. A copy of this complaints procedure was seen to be placed on a notice board which is visible to service users. In addition, it was noted that within the service user plans that were inspected as part of a carer’s agreement, which is signed, a copy of the complaints procedure is issued to the main carer. Unfortunately service user meetings have ceased where that service users are encouraged to voice any concerns they may have about the home. These should be reinstated not only for service users to voice concerns but to keep service users informed about what is happening in the home. See Standard 8. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 21 The home keeps a log of all formal and informal complaints. We were able to view this. There was one complaint since the previous inspection in August 2009, from a service user about another service user. The complaint has been investigated and there were notes, which provided details of the complaint and we were told about the complaint and what was being done to rectify it. Since the last inspection we have been kept informed about any incidents that have happened in the home and the outcome. These have mainly been service users not returning when they said they would and the service users not following the procedures agreed with the home and their care manager. We spoke to four service users who said they knew about the complaints procedure and would complain if they needed to. The service user who lived at the home permanently said they knew when and how to make complaints if needed. They said any concerns they had they would speak to the deputy manager or a member of staff. The home has robust policies and procedures on adult protection and whistle blowing. In the past there have been referrals under the safe guarding adults and this was investigated following the organisations procedures. We were told all new staff attends training on safeguarding of vulnerable adults as part of their induction. Staff we spoke to said they had received training on safe guarding issues as part of their induction and records held in staff files confirmed this. The home also has a comprehensive policy regarding the management of service user finances. We checked the money held by the home for service users who were staying at the time of the inspection. Staff told us this was checked at every handover shift and signed for. One service user told us they managed their money and had saved a large amount that they had spent on a party so it meant they had no money for a while. The service manager and the deputy manager said they were trying encourage the service user be more responsible about their finances and there had been a number of discussions about this with them. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,29,30 People using the 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 is safe, well maintained and comfortably furnished with adequate private and shared space. There are good facilities and adaptations available to meet a range of service users needs. Recent redecoration and adjustments have improved the facilities and further improvement work is planned. EVIDENCE: The home provides accommodation for one permanent placement, and for short and long term stay. The home is spacious, comfortable and generally well decorated and maintained and the size of the building allows for service Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 23 users to access different areas of the house. There is no access to the upstairs areas for people with mobility issues. We found the home was very clean and free from offensive odours on each of the days of the inspection. The home is cleaned daily by staff and service users who are encouraged to do household tasks as part of developing their daily living skills. We were given a tour of the home. Since the previous inspection some bedrooms and the living areas have been redecorated and new furnishings have been purchased. The kitchen has been decorated and refurbished to make it easier for service users to use and there is a small fitted kitchenette on the first floor which has just been refurbished and is in the process of having a small seating area installed. The home has lots of shared space that service users are able to use. The entrance hall is large and welcoming with a seating area. There are three lounges / dining rooms and a sensory room. One lounge is known as the quiet lounge where service users can sit quietly and relaxing. We spoke to the new manager before the inspection who said she would like to develop the potential of the home by maximising the rooms and space and in this way develop the service. This will create specific areas to which provides specialist support for particular groups of service users. For the duration of their stay all service users are provided with their own bedroom. One service user, who lives in the home permanently, is hoping to move to a larger bedroom within the home that will be more suitable and meet their changing needs. The registered manager said the room has been decorated in the colours they have chosen. Because they live there permanently they have brought in their own possessions, which made the bedroom their own and this has a homely feel to it. Each bedroom is comfortably furnished but as was stated in the last report, because it is a respite service some bedrooms do not have a homely feel because of lack of personal possessions. The home has four bathrooms with toilet and one ground floor bathroom is fitted with a bath lift. In addition, the ground floor has a walk in shower room, with toilet facilities, a portable universal shower chair and portable table. We were told the ground floor bedrooms are given to service users with the higher mobility needs. There are some adaptations to the home to assist service users who have physical disabilities. Two hoists are available for service user requirements. The home has good laundry facilities and an adequate policy and procedure for control of infection. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment arrangements are robust and residents are safeguarded by staff that are thoroughly vetted. Residents individual and joint needs are met by appropriately trained staff. There is a friendly, motivated and competent staff team. Staff has regular supervision and are supported in their work. EVIDENCE: We checked the staff rota and this reflected accurately the staff members that were on duty. It was evident through observations and from the rota that there were enough staff members working in the home. We were told by the deputy manager some service users needed one to one support and this is reflected in the rota. The rota confirmed this. We spoke to one member of staff Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 25 who said they usually worked on a one to one basis with the service user and supported this service user to go out or follow an activity in the home. We checked the staff handover sheet. Staff said they go through the handover checks at each handover. This includes checking the money held on behalf of the service users. The oncoming member of staff signs a record of this. The home has a daily task sheet for each shift that is signed by the member of staff who completes the task. This is handed over during the change of shift as well as giving verbal feed back. The home has had a number of new staff start to work in the home over the last year since the previous inspection in July 2008. We met six staff during the course of the inspection and were able to speak to five. Three were new members of staff. One member of staff has worked for the organisation for more than twenty years. They said things were changing in line with the new way of thinking. The new staff said they felt they had good induction training and were supported by the deputy manager. Another said they had five day induction training and spoke about the recruitment process which they thought was thorough. Staff said they were given the opportunity to go on other training relating to the service users who use the service and hoped to go on to take NVQ 2 or 3. They said they had regular supervision and staff meetings where they were able to discuss any issues that concerned them. Throughout the inspection we observed staff interacting with residents and the qualities seen included good listening skills, a calm and confident manner, and a good grasp of the basic areas of need they needed to meet, including communication. As part of the inspection process we visited the organisations head office human resource department where all the staff files are held. We were able to check the recruitment procedures and practices as well as the staff files. We selected twenty two files of support staff that have been recruited by the organization in the past twelve months. These were of staff who worked in a variety of settings in the organization, such as outreach services to residential care units. A human resource manager was appointed and has been in post for the past eleven months. The previous issues of concern were the competency of staff involved in verifying documentation. We found that there are notable improvements in the recruitment procedures at this inspection. The human resource manager has the experience and the skills in verifying applicants’ identity and work permits and is very thorough in this aspect of recruitment. We saw the records on file of contact with external organisations that follow up on any concerns regarding employment and immigration status. We saw that there were face to face interviews were conducted by two senior officers and notes were kept of the results. The outcome of the interviews is used in the selection and appointment process. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 26 The human resource manager has identified gaps in some of the older files and is continuing to address these. Staff recruited now are more thoroughly vetted with relevant documentation in place that provides evidence of this. Using the organizations information sheet correctly have helped improve the procedures. It is held at the front of the personnel file and is easily accessed to check that the applicant’s information is received before proceeding with the appointment. All the files we viewed contained fully completed application forms with proof of identity. Relevant references present are supplied from previous employment and match up with employment history. Copies of identity and CRB Enhanced Disclosures are held. We saw records that confirmed these are obtained before staff are appointed. Support staff are issued contracts and copies of these are retained on staff files. We looked at three new staff files who work in the home. Of those files of staff who work in the home all had an employment contract, which includes details of their terms and conditions of employment that they had signed. The home protects residents by obtaining references, CRB Enhanced Disclosures with relevant POVA checks were present for each staff member. We were told by the manager that all staff employed receive a structured induction process that meets skills for care requirements. The organisation provides a wide range of training for the staff team mandatory training including manual handling, food hygiene, infection control, first aid and other general health and safety training and this is updated as required. We contacted the organisations training department and they were able to confirm staff in the home had completed a wide range of training and that mandatory training takes place each year. We saw copies of the training file that is kept in the home. The staff said they receive regular supervision once a month and said they felt they could talk to the deputy manager whenever they are around. Copies of staff supervision notes, which are signed, by a manager and a staff at the end of the supervision to confirm the goals set in a meeting are kept locked in the staff office. We were shown copies of staff meeting minutes that are held every two months. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42,43 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a home that is well run and managed. The registered manager is qualified and experienced and runs the home well. Working practices and associated records need to be more robust to ensure that the service user’s health and safety and well being is maintained. EVIDENCE: The complete management of the home has recently changed with the service manager, the registered manager and the deputy manager leaving and / or Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 28 moving around within the organisation in the last few months. The service manager and the deputy manager have already started work in the home and the manager is due to start in the home in the middle of August 2009. All have been working for the organisation for a number of years. We met the service manager who is very approachable and has many years experience within the service. They said they have been spending more time in the home in the absence of a manager to support the deputy manager. The deputy manager started in the home in February 2009 and is running the service well with the support of the service manager, administrator and staff. Sixty plus service users use the service and even with the support of the service manager it is a large service to develop and manager without the full time support of a registered manager. They have carried out the tasks allocated to the manager as well as holding service user reviews, doing new assessments and supporting staff to put in place the organisations new support plans and related paper work. The deputy manager has experience in being the deputy manager is other services in the organisation and this is good experience in her personal and professional development for her to become a registered manager. There a business plan that is reviewed each year that states how the home aims to improve over the next year. The homes managers have regular meetings with senior and executive management, to discuss and plan the homes requirements. We met the new manager prior to the inspection and they said they had visited the service and would be looking at ways the service could be improved and developed when they start in the middle of August 2009. We were told the home is using the self-auditing system called a “Practical Quality Assurance Systems for Smaller Organisations (PQASSO)”. As part of the home quality assurance, questionnaires are sent to service users and carers. There are monthly person in control inspections by senior management that are fed back to the home to raise improvements in the home and the service. Copies of these are kept on file. The home has policies and procedures in place around health and safety. The records we saw indicated the homes health and safety services and equipment have been checked, serviced and maintained at the appropriate intervals. There is an annual meeting and inspection by local fire officer. We saw there was a copy of the fire certificate floor plan and risk assessment on file. There is a fire procedure in place. The break alarms are being tested weekly and firefighting equipment has been checked regularly. Fire drills have been carried out with service users at various times of day on different days, ensuring all staff have taken part in fire drills over the course of six months and there is a record of the date and time drills have been carried out. The organisation has recently updated the procedures for carrying out a comprehensive risk assessment with services. House risk assessments as well as COSHH risk assessments are in place. Copies of the reports and records of the checks are kept at the home. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 X X 3 3 Version 5.2 Page 30 Holmbury Dene DS0000025625.V375973.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) Requirement Timescale for action 30/09/09 2 3 YA8 YA22 YA20 12 Sch 4 13(2) The registered person must ensure the care plans are audited and contain enough information to enable staff to support service users in the way they want their care delivered. The registered person must 30/09/09 ensure service users meetings are reinstated. The registered person must 30/09/09 ensure that staff administer, sign and count the service users medication to ensure the medication has been given correctly. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations Service users should be risk assessed and if found capable should be encouraged to develop their skills and independence to be able to self medicate. Holmbury Dene DS0000025625.V375973.R01.S.doc Version 5.2 Page 31 Care Quality Commission North Eastern Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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