Inspection on 25/08/09 for Holcombe House

This inspection was carried out on 25th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holcombe House 17/07/07

Holcombe House 08/05/06

Holcombe House 05/10/05

Holcombe House 04/05/05

Holcombe House 19/10/04

Holcombe House 21/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Holcombe House Butterton Lane Moretonhampstead Newton Abbot Devon TQ13 8PW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Holcombe House Butterton Lane Moretonhampstead Newton Abbot Devon TQ13 8PW 01647440241 01647441146 sueowens@btinternet.com www.holcombe_house.co.uk Mrs Sue E. Owens care home 21 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Holcombe House is registered to provide accommodation and care for up to twenty-one people who are over sixty-five and who may have dementia and/or a physical disability. Any medical or nursing necessary is met through the community medical services. The home is about half a mile from the centre of Moretonhampstead and has panoramic views over Dartmoor. There are 17 bedrooms, four of which are large enough to be occupied by two people. There is a pleasant dining room adjoining the lounge at the back of the house, and another lounge and conservatory at the front. The extensive grounds provide an attractive setting for the home. Care Homes for Older People Page 4 of 33 Over 65 0 21 21 21 0 0 Brief description of the care home A written Statement of Purpose and the most recent inspection report are available on request at the home, and a Service Users Guide will be sent to prospective residents on request. The weekly fees are currently between £625 and £391 and additional charges will be made for professional hairdressing, chiropody, newspapers and toiletries. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has collected information about Holcombe House since the previous key inspection 2007. Toward this inspection we sent surveys to people who use the service (4 were returned, mostly completed by their family), and staff (8 were returned). We also contacted a district nurse who visits the home regularly. The home provided us with information about the service. This includes data, such as how many staff work there and when policies were last reviewed. It also gives the home the opportunity to tell us what they do well, any barriers to improvement and what improvements are planned. We did two unannounced visits to the home. We looked closely at the care of three people who use the service. This included meeting them, speaking with staff about their needs and examining records pertaining to their care. We also observed staff going about their work and their interaction with people. Care Homes for Older People Page 6 of 33 We saw most of the building at both visits and several bedrooms. We examined some policies, procedures and records. We asked questions of staff and the manager, who was present throughout. People who use the service may be described within this report as residents, clients, service users or patients. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Peoples needs and wishes must be fully assessed before they are admitted. Any additional information required must be sought. This assessment must form the basis of planned, individualised care. It must be regularly reviewed after consultation with the person using the service, or their representative, where this is not possible. Care Homes for Older People Page 8 of 33 Peoples plan must be followed by staff to ensure all aspects of care are understood and provided. Non-prescribed medicines should not be given to people until the Homely Remedies policy is agreed with peoples G.P. and is properly in use. The home should purchase the correct storage for medicines known as controlled drugs so that, should people be prescribed them, the home is not in breach of the Misuse of Drugs (Safe Custody) Regulations 1973. All staff must know the correct procedure for alerting concerns which might be abuse. The homes whistle blowing policy must inform staff how they are protected in law if they alert concerns and the correct authority, with contact details, for doing so. People should have access to safe outdoor space which they can visit independently. To this end there should be easier access to the gardens and patios. Peoples independence should be promoted. To this end there should be more hand rails for those with poor mobility and adaptation to help people with memory problems and poor understanding. There are guidelines available for this. There should be staff hand washing arrangements for any time personal care is delivered. This should include liquid soap and paper hand towels. This will help reduce the possibility of cross contamination. The home should draft policies and procedures so its obligations under the Mental Capacity Act 2005, and deprivation of liberty safeguards, can be met. There should be a more systematic cycle of planning, action and review so that improvement can be measured. Records required by regulation for the protection of people and the effective running of the home must be up to date and accurate. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make an informed decision as to whether the home is suitable to meet their needs but the standard of assessment does not ensure those needs will be fully met. Evidence: Each of the four people who responded to survey told us they received enough information to help them decide if the home was the right place for them. Each also told us they have been given information about the homes terms and conditions; the contract. The home reports: Our service users guide has yet again been updated with relevant new information including funding categories, those we care for, testimonials, access to information and how to access it. Also our statement of purpose has more up to date information. A web site is now live although we are still looking to improve it, and are in the process of updating, to ensure that people who look at our site are in no Care Homes for Older People Page 11 of 33 Evidence: doubt we are an EMI home. We looked at how well peoples needs are assessed before the home can decide if those needs can be met and how they plan to meet and support individuals. We looked closely at the assessment records of two people who use the service and in less detail at some other assessment records. The manager was invited to provide any additional information. There was evidence that people, or their representative, had been involved in providing information and some had information provided through their local authority social worker/care manager. We found the standard of information available was variable, mostly brief and some contradictory. There was no medical history available for two people. For one their daily notes repeatedly record that they shake a lot, but the assessment gave no indication that this was a problem. One document called an Admission sheet only recorded: constipation, dislikes pork, peas and tomato and uses walking stick. There were some completed assessment tools (for pressure sores and nutrition) but not all had been signed and dated, essentialy making them useless. Although in one document it was stated the person had a history of falls, one which led to permanent skin damage, the home had not completed a falls or moving and handling risk assessment so any risk to them could be managed. We found that the poor assessment of one person had led to poor planning and as a consequence their needs were not being met. Medication taken prior to admission was not being given once admitted and no person had checked whether it should continue. There were repeated records of the person having poor nights and staff were administering pain killers to try to help them. Their assessment and plan were inadequate, this affected the care delivered and their well-being. There was some good personal information about people, very important where people have dementia and lack the ability to describe what is important to them. However, this was not found in each of the records examined. We looked at whether the home is aware of legal arrangement in place to protect those who are unable to make decisions on their own welfare. The home uses a document called: Thinking ahead but some had nothing recorded under the heading. The home must ensure that a record is made of any Advanced Decision to refuse Care Homes for Older People Page 12 of 33 Evidence: treatment, whether Lasting Power of Attorney arrangements are in place, Independent Mental Capacity Advocate or Best Interest person acting on their behalf. We asked two care staff if they have the necessary information they need available to help them provide appropriate support and care. They told us: We would like much more in depth profiles about people. We confirmed that the manager and/or deputy visit people in their own home to make assessment of their needs. We were told that time is spent making a judgment as to whether the home is the right place, or not, for the person. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although a very high standard of personal care is delivered people have little or no input into how their care needs and wishes are to be met, plans are not reviewed and staff have little documentation to provide them with information. Evidence: Each person living in the home must have a plan of care that accurately reflects his or her care needs and identifies the action required by staff to meet those needs. The plan of care must be reviewed regularly in consultation with the person or their representative and updated when the persons needs change. This is to ensure that a persons changing needs are assessed and met. The home reports: Our clients welfare is paramount and the care they are given reflects in their behaviour, their health and their longevity. We looked closely at the care of two people at the home, briefly at some others and the manager provided information. Each person has a plan of how their basic routine needs will be met, such as how to Care Homes for Older People Page 14 of 33 Evidence: assist them with personal care and to move safely. This is kept in their bedroom so accessible for staff use. Additional care planning records are kept by the staff. Although some included information of importance, others provided only a minimal amount. Neither were the plans regularly reviewed or current. Four staff told us through survey that they are always given up to date information about the needs of people they support and care for, two said they usually are and one said sometimes they are. We spoke with two care staff asking them how they care for people and about care planning. One said: We would like much more in depth profiles about people. We asked a senior carer how staff receive information about people. she told us: Shadow (other staff) when new, reports and we are told. Asked about care plans she agreed that they were not much use. We found very little information to suggest that people, or their representative, were consulted about how their care would be delivered. Family of one person visiting told us they were kept informed but they were not in any way part of the care planning and their relative would be unable to do this themselves. This reduces the likelihood of individualised care being provided and it reduces peoples independence. Whilst care plans are very important we looked to see if the actual care provided was of a sufficiently high standard. Each of the four people who responded to survey told us they always receive the care and support they need and each told us they always get the medical care they need. A district nurse told us: The standard of care is excellent. Nine out of ten times they contact us it is appropriate. Their accountability is very good. One lady has been in bed for seven years and never got a pressure sore. Senior carers are very good. However, we found that the poor assessment of one person had led to poor planning and as a consequence their needs were not being met. (See the Outcome called Choice). We saw that the standard of personal care provided was very high. Staff are skilled in meeting peoples personal care needs and preventing problems such as pressure sores. We looked at how the home assists people to manage their own medicines or does this for them. We found that general medicines are stored securely and records are clear and well recorded. Medicine use is recorded so that a full audit should always be possible; this includes the use of codes when a medicine is not taken. The home keeps good information about medicines for staff to reference. Care Homes for Older People Page 15 of 33 Evidence: We were told that there is a policy for administering over the counter non prescribed medicines (such as pain killers or cough medicine) but this is not yet in use. However, we know that these medicines are being given. Also, the home does not have the required storage arrangements for any specialist medicines known as controlled drugs. They should arrange this at the first opportunity for when it will be needed. We saw staff interacting with people in a sensitive and respectful manner. The manager reports: I insist on high standards in the principles of care, privacy and dignity are of paramount importance for the well-being and individuality of our clients. We maintain our knock and wait policy, and Manager and Senior Staff ensure all clients are treated with the utmost dignity and respect, all staff adhere to the Privacy, Dignity and Confidentiality policies. Although most comments regarding the home and staff were very positive one person told us staff had, in the past, sometimes talked over people inappropriately. They confirmed that they had brought this to the attention of the manager and some action had been taken. Some bedrooms have keypads to restrict entry and provide privacy and ownership. The manager told us that those can be opened easily by the people who have chosen to have them. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to lead fulfilled lives within their capabilities and food is very much enjoyed. Evidence: We looked at what experience of daily life people have at Holcombe House. Two people who responded to survey told us that the home arranges activities that they can take part in if they wish. One person said the home usually does and one said this did not apply to them. One person, however, commented: We would like even more one to one time with residents and more use of garden. There are lots of organised activities at the home including group chair exercises with a physiotherapist, Tai chi, hand massage and quizzes. The home keeps pets and plants have been grown on the patio. The home reports: Cookery Club. This is done with risk assessments in place and with just 2 or 3 clients at a time. We now have a notice board in the hall to enable those who can to see the activities for the week. We now put a diary message in the local monthly magazine every month with news from Holcombe. Our Newsletter goes out Care Homes for Older People Page 17 of 33 Evidence: each 1/4 to visitors and local establishments. It is also reported that the home makes use of community transport for visits away from the home. Assessment and care records contained very little information about the individual person which is especially important where they may have difficulty expressing wishes and interests. One staff told us how people would benefit from a more personal profile on people. Although activities within the home are arranged and regularly go ahead this does not automatically mean that peoples individual needs and preferences are being met. Family of one person told us through survey: Very comfortable, welcoming atmosphere for residents and visitors. There are no visiting restrictions at Holcombe House and people told us of the homely feel. The home reports: Visitors enjoy coming especially for afternoon tea and homemade cake. We looked at the standard of food provided. Three people told us through survey that they always like the food provided and one told us they usually do. One person added: The food is excellent. The home reports: After three members of staff attended a half day course on Nutrition in Dementia Care, we have this year updated the homes menu, to be more nutritionally balanced but still incorporating the clients favorites. We were told that the home intends provide a more varied menu and choice everyday for lunch and supper. However, the menu we were shown was very varied. Where people needed assistance with eating we saw this provided sensitively. We spoke with two people visiting the home. They confirmed that people are offered choice and they are encouraged to rise and retire to bed when they prefer. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Vulnerable people are protected at Holcombe House but the safeguarding arrangement leave room for improvement. Evidence: We looked at how well people are protected through the homes complaints and safeguarding arrangements. The home reports that there have been no complaints and the Commission has not received any complaints about the service. The complaints policy can be found by the entrance to the home and also in the Service User Guide to the home. It contains timescales for response and also the contact details for the Commission. However, these were out of date. Three people who responded to survey told us that staff always listen and act on what they say and one said they usually do. Each person who responded to survey told us they knew someone they can speak to informally if they are not happy and that they know how to make a formal complaint. The home reports that staff have received training in how to safeguard people from abuse. Three staff we spoke with knew the types of abuse. The told us they had not received specific training in safeguarding but it came into other training. Care Homes for Older People Page 19 of 33 Evidence: We asked two staff if they knew where to find the whistle blowing policy. This policy should inform them how to alert any concerns correctly so that people are protected. The two knew where to find it but a third staff we less certain. We found the whistle blowing policy to be very minimal in content. It does not inform staff that they are protected in law if they alert concerns and it makes no mention of the local authority safeguarding team; the people concerns should be taken to. We asked senior staff how they should respond to an alert which might be abuse and they did not know the correct procedure. Although many comments about the home describe a genuinely caring staff and management, and we believe that abuse would not be tolerated, all management and staff should have a working knowledge of safeguarding policy and procedures. There have been no safeguarding alerts associated with Holcombe House prior to the inspection. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and homely environment but their independence and wellbeing are compromised. Evidence: We visited the home on two occasions both times looking around the building. We were told through survey that the home was very comfortable. The communal spaces appeared to be very pleasant and comfortably furnished. Most bedrooms contained personal items and were individual to the occupant. People are able to lock their bedroom doors if they wish. There have been ongoing concerns regarding health and safety of the environment, with recommendations going back to 2005. These include the need for covers to be fitted to all radiators to eliminate the risk of residents scalding themselves. This has still not been fully achieved. However, we were told there is now a program of covering radiators, risk from those not covered has been assessed, and we saw that each of the ground floor bedroom radiators has been made safe. We had previously required that hot water to wash basins, which posed a risk of scalds to people, be made safe. This has now been completed. At the July 2007 inspection we recommended that the surface of the area around the Care Homes for Older People Page 21 of 33 Evidence: house be further improved to allow people who use the service easier access to the gardens and patios. We found during this inspection that there is no safe outside space that people can visit independently. Staff told us that they would always accompany a person outside but that is not true independence. We discussed with the manager possible ways people can have level access to safe and pleasant outside spaces. We also said that it must be very clear, in the information provided to potential residents, that secure garden space is not available. We looked to see how well the home had been adapted for people who use it. We found almost no adaptation for people with dementia who would benefit from pictorial signage and clear demarcation of space using colour. There was one large sign to the ground floor toilet and one person had their name and coloured signage on their door.) We saw that many people at the home have mobility difficulties but areas of the home lacked hand rails and there were steps to the patio and garden. We saw several people use a walking aid and are therefore at higher risk of falls where there is no level access. Staff told us that they have the equipment they need, but one said more hand rails are needed. We asked senior staff if there were adaptations in the home and were told: Not to my knowledge. We looked at the suitability of the laundry arrangements. There are high specification machines which will meet the needs of the home. The laundry room is small but was very clean. The home uses a non-touch system for soiled laundry which reduces the likelihood of staff transferring infection. Liquid soap and paper towels were available for hand washing in the laundry and there were different containers so that laundry can be separated to reduce cross contamination. We found that peoples bedrooms do not contain a hand washing facility for staff, important when they are providing personal care to people. Staff told us that they go to a bathroom to wash their hands, they use gloves and aprons and antiseptic hand gel. However, following the provision of personal care staff should wash their hands before leaving the room. Three people who responded to survey told us that the home is always fresh and clean and one person said it usually is. One person added: . The home is always immaculate. The home was bright, fresh and clean when we visited. Care Homes for Older People Page 22 of 33 Evidence: The home appeared to be very well maintained. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a staff which is consistent, skilled, knowledgeable and keen to do their work well. Evidence: We looked how well the staffing arrangement benefit people who use the service. We were told: The staff are very caring. One staff member told us: The staff are good. Another said: We keep up to date with training and are always offered courses. Good group of carers with good knowledge. Staff told us that the numbers of staff employed are mostly satisfactory and staff turnover is very low providing continuity. The manager ensures that a senior member of staff is always on duty. When we visited we found staff numbers to be satisfactory and care staff were supported by a cook and domestic support staff. Seven staff who responded to survey told us that their induction training covered everything they needed to know to do the job when they started. One told us it partly did and one said it mostly did. Seven of the eight staff who responded to survey told us that they are being given training which is relevant to their role and that training helps them understand and meet the individual needs of people. Six of the eight staff told us their training keeps Care Homes for Older People Page 24 of 33 Evidence: them up to date with new ways of working and four of the eight said it gives them enough knowledge about health care and medicines. A district nurse with good knowledge of the home told us: Senior staff are excellent and senior carers are very good. The manager told us that training is very, very important and all staff take some responsibility for learning. The home reports that staff training is now more structured, but we were told there was no training schedule. It is also reported that qualifications in care are being completed regularly and training is now on a regular basis, with regular refreshers in-house. The manager has a particular interest in the training of staff. She told us that she has completed a refresher in Manual Handling Training, and all staff have completed training or refresher training. We asked staff about the training they receive. Asked what would constitute good care for people who live with dementia we were told: Empathy is VERY important. Asked about training in dementia care we were told: Yes, but more on dementia would always be appreciated. Staff told us that the training they received last year included: moving and handling, 1st. aid, infection control, health and safety, food/swallowing and helping people eat, activities management and fire safety. The home reports that eight of the fourteen permanent care staff have National Vocational Qualifications (NVQ) in care, to 2 level or above. This is an indicator of staff competence. We intended to look at whether the recruitment practice at the home ensures staff are safe to work with the vulnerable people resident, but the last staff employed started February 2007 and so there were no current records to inspect. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interest of people who live there. Evidence: People said of Holcombe House: Generally we are very happy with the care my mother receives and she appears to be content and I cannot speak highly enough of Holcombe House. Staff said: The management and staff do care genuinely for the residents. The registered service provider, Mrs Sue Owens, is also the Registered Manager of the home. She has over 20 years experience at the home. She holds an Advanced Managers for Care Award (City & Guilds) and an ESCC Social Care Qualification. She is an NVQ Assessor and moving and handling trainer. There is a deputy manager to support her who is undertaking qualifications in management and the home always has at least one senior carer available. The manager was present for both inspection visits. Care Homes for Older People Page 26 of 33 Evidence: We looked at how the manager assesses the quality of the service provided. There is a more formal quality assurance system in place since the previous inspection. The home reports: We have taken possession of a new software package of complete care home management this allows us to accurately monitor all aspects of staff and resident records including training, individual care and occupancy levels to assist in providing optimum quality care. The manager told us she and her deputy have a lot of practical input at the home. There is a hierarchical system for providing care which ensures staff accountability; something a district nurse also mentioned. The home surveys opinion from health care professionals, people who use the service and their family, but, we are told: Not on a regular basis. Staff opinion is not surveyed and we would strongly recommend this. We asked if the home has drafted policies and procedures so its obligations under the Mental Capacity Act 2005, and deprivation of liberty safeguards, can be met. We were told: As yet no, but some staff have attended training. Staff told us they have supervision of their work. Asked about staff meetings we were told: Rarely and they are more announcements. However, the manager reports that meetings include training sessions. For example, a G.P. attended to talk about dementia care and mental health. The home still does not have a clear systematic cycle of planning, action and review to ensure standards are maintained. We were told that there have been no changes in the arrangements for supporting and safeguarding peoples finances. It is the policy of the home not to manage peoples finances but to ask them and/or their relatives to make their own arrangements for this if necessary. Any out of pocket expenses that people may have are either paid for by the home and billed to the persons representative or paid for in advance by the persons representatives. This system is recognised as good practice as it provides safeguards for both the people who use the service and staff. Five staff who responded to survey told us that they regularly get enough support and meet to discuss how they are working, one said they often do, one said sometimes and one did not reply. Staff told us their work is supervised but one added: There could be a bit more communication. We found that the standard of record keeping at the home was very variable. We were very concerned at the level of record keeping regarding assessment of peoples needs and planning of their care. However, the medicine administration records were detailed and clear. Some policies and procedures were adequate in content whilst Care Homes for Older People Page 27 of 33 Evidence: others lacked detail. The home was required to provide dates of reviews of their policies and procedures but did not do so. We know that some have been reviewed and updated, for example, the Statement of Purpose. Records required by regulation for the protection of people and the effective running of the home must be up to date and accurate. Safe are trained and competent in aspects of health and safety. We saw no health and safety concerns relating to non maintenance of the building and were shown records that the electrical circuit has now been tested professionally. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 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 Following consultation there 31/10/2009 must be a suitably detailed assessment of the wishes and needs of any person who is admitted into Holcolmbe House. Where information is lacking this must be sought so a full picture of their needs and wishes is available. So that the home can determine if their needs can be met and a plan formed of how those needs and wishes will be met. 2 7 15 After consultation with the person, the home must make a written plan of how their needs are to be met. The plan must be reviewed and updated as preferences and needs change. So that staff are aware of what care and support the person needs. 31/10/2009 Care Homes for Older People Page 30 of 33 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 3 18 13 The homes whistle blowing 30/11/2009 policy must adequately describe what protection staff have in law should they alert concerns, exactly how to do so and the contact details for the local authority safeguarding team. To protect the vulnerable people in their care. 4 18 13 All staff in the home must know the agreed procedure for alerting concerns which might be abuse. To protect the vulnerable people in their care. 30/11/2009 5 24 13 All radiators within peoples rooms must be guarded, or have low temperature surfaces. To prevent the possibility of contact burns. 31/12/2009 6 37 17 Records required by regulation for the protection of people and the effective running of the home must be up to date and accurate. For the protection of people who use the service and the efficient running of the business. 30/11/2009 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. The home should make arrangements to comply with the Misuse of Drugs (Safe Custody) Regulations 1973 so that, should controlled drugs be prescribed to a person living in the home, the service will be complying with those regulations. The home must ensure the policy on Homely remedies is completed so that these medicines can be given within the structured and agreed framework for doing so. The home should be adapted to meet the needs of people who use it and within current guidelines and good practice recommendations. This includes handrails and level access for people with reduced mobility and signage and other indicators for people with impaired memory, reasoning and dependence associated with dementia. Staff should be able to wash their hands where ever personal care takes place, including peoples own rooms. To this end liquid soap and paper towels should be available. This will reduce the likelihood of cross infection. The home should draft appropriate policies and procedures to ensure obligations under the Mental Capacity Act 2005 and deprivation of liberty safegaurds will be met. There should be a systematic cycle of planning, action and review so that improvement can be measured. 2 9 3 9 4 22 5 26 6 33 7 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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