CARE HOMES FOR OLDER PEOPLE
Holcombe House Butterton Lane Moretonhampstead Newton Abbot TQ13 8PW Lead Inspector
Judy Hill Unannounced 4th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Holcombe House Address Butterton Lane, Moretonhampstead, Newton Abbot, Devon, TQ13 8PW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01647 440241 01647 441146 Mrs S.E. Owens Care Home 21 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (21), Physical disability over 65 of places years of age (21) Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 19th October 2004 Brief Description of the Service: Holcombe House is registered to provide accommodation and care for up to twenty-one people who are over sixty-five years of age and who may have dementia and/or a physical disability. The home is situated on the outskirts of Moretonhampstead but is within walking distance of the small moorland town. The home accommodates both men and women and most of the bed-sitting rooms are single rooms with en-suite facilities. The communal rooms are light and spacious. Meals are cooked on the premises. The owner/manager works at the home on a full-time basis and lives in the grounds of the home, so is regularly on-call when she is not on duty. The staff turnover is low. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out over four hours. The registered provider, Mrs Sue Owens who also manages the home, was present throughout the inspection. At the time of the inspection the home had twentyone residents and no vacancies. All of the residents were seen and five of them were interviewed in private. Five members of staff were observed working with the residents and spoken with. A partial tour of the premises was carried out and samples of records, including service users assessments, care plans and medication administration sheets were inspected. The contents of the Statement of Purpose and the Service User’s Guides were discussed with the registered provider. Lunch was seen being prepared and served. What the service does well: What has improved since the last inspection?
Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 6 The storage, and the procedures for handling and administering the resident’s medicines have been improved and the new practices that are in place greatly reduce the risk of errors being made and safeguard the residents. Commercially produced Induction and Foundation training packs have been purchased to ensure that this meets National Training Organisation specifications. Some additional on-going training has been provided, but there is still some room for improvement in training provision. Some of the staff are working towards gaining NVQ qualifications in Care. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 3 Prospective service users and/or their representatives are not given all of the information they need to make an informed choice about where to live. New residents will not be admitted unless an assurance can be given by the home that their needs can be met. EVIDENCE: The Statement of Purpose was seen and is being made available to prospective and existing residents and their representatives. This document is very clearly and concisely written and informative but does not contain all of the information required in the regulations. The progress of producing Service Users’ Guides was discussed with the registered provider and although some of the information that needs to be included in them was seen in draft form, finalised versions of the Guides have not yet been made produced and made available to the service users. The registered provider has produced a Statement of Terms and Conditions and this was seen, but this document, which should be personalised and
Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 9 included in the Service Users’ Guides, does not contain sufficient information about the service users rights and responsibilities. The information required to be included in the service users assessments is recorded and used to inform service delivery. However, this information is kept in a number of different locations and it is suggested that more use could be made of the resident’s case files keep a master copy of all of the information gathered during the assessment process. Three of the residents interviewed in private said that their needs were being met. The other two residents interviewed were unable to answer direct questions but appeared to be happy with the care provided. The registered provider and the staff demonstrated both verbally and in their interaction with the residents that they are aware of their individual needs. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8, 9 & 10 The owner/manager and staff are sensitive to the individual needs of the residents and the quality of the health, personal and social care provided is good. The resident’s medicine is handled conscientiously to minimise the risk of errors. EVIDENCE: The residents were seen to be clean, well dressed and well groomed. Care plans were seen inside the individual residents wardrobe doors, which provided both the staff and residents with details of the individual their daily personal care needs. The resident’s health care needs are monitored and timely referrals are made with the primary and secondary health care services as evidenced by records of appointments and consultations. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 11 As most of the residents have dementia, the staff administer all of their medication. The storage of medication was seen to be appropriate and the administration records were seen to be clear and up to date. The registered provider and staff were seen to be treating the residents with dignity and respecting their privacy by knocking before entering their rooms. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Daily routines are flexible and enable the residents to exercise choice. A good range of activities is provided for residents who choose to participate. The resident’s families, friends and representatives are made welcome. The residents enjoy well-prepared meals. EVIDENCE: One of the Care Assistants said that she had held a meeting with the residents to discuss the provision of social, recreational and occupational activities with them as part an NVQ (Level 3) assignment and that their suggestions regarding the timing and content of had been used to revise provision. Organised activities are held in one of the lounges most afternoons, after a rest period following lunch, and are advertised on a notice board. There are two lounges so residents who do not want to take part can sit in the quiet lounge or stay in their bed-sitting rooms. The staff were observed asking residents it they wanted to take part in the afternoons activities. One of the service users interviewed said that he did not like to socialise but preferred to stay in his room and watch television or listen to music and that his preferences are respected.
Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 13 The Statement of Purpose encourages the residents to maintain links with the community and with their families and/or advocates, who are invited to participate in the care planning and review meetings. Three of the residents interviewed said that members of there families visited them regularly. A meal of lasagne, chips and peas, followed by chocolate sponge and vanilla custard was seen being prepared and served. Three of the residents interviewed said that the food was excellent. The registered provider said that the home could cater for people on special diets. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 EVIDENCE: Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 24, 25 & 26 The home is clean, well decorated and comfortably furnished and provides a pleasant and homely environment for the residents. The resident’s safety is being put at risk by the temperature of the hot water. Care and consideration is taken to ensure that the residents clothing is washed safely. EVIDENCE: A partial inspection of the premises was carried out. A sufficient number of toilets are provided. Six of the bed-sitting rooms have en-suite bath or shower facilities but these have been capped off to prevent them from being used. This leaves two communal bathrooms to be shared by twenty-one service users which does not meet the minimum standard of one bath or shower per eight residents. The plugs have been removed from some of the wash-basins, which the registered person explained was to remove the risk of flooding. The water
Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 16 temperature was tested manually and found to be too hot to use comfortably to wash and rinse hands. There is a risk of residents scalding themselves and of residents, staff and visitors not being able to wash their hands thoroughly, thus increasing the risk of infection and the spread of infection. The home was seen to be clean, attractively decorated and comfortably furnished. The service users had brought personal possessions, including furniture into the home with them and the bed-sitting rooms that were seen had all been personalised by their occupants. It was observed that the service users bed-sitting room doors had not been fitted with locks. The registered person said that the residents did not have lockable facilities in their rooms. The laundry facilities were seen to be satisfactory. Notices had been placed on the walls reminding the staff to take care when washing the residents clothing and named baskets were seen to separate washed items. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The resident’s needs are being met by an experienced and well managed staff team. The staff receive training but the provision of additional training would benefit them and the residents. Staff recruitment practices are too informal and do not offer sufficient protection to the residents. EVIDENCE: All of the staff are employed to carry out both care and ancillary duties. At the time of the inspection four members of staff were on duty with the registered provider. Both the home and the residents were seen to be clean and well cared for. Two members of staff and the registered provider said that the staff are encouraged to spend time talking and socialising with the residents. Three of the residents interviewed said that the staff were attentive and able to meet their needs. One staff file was inspected. It contained an application form but no references, CRB and POVA checks, contract or terms and conditions of employment. This was discussed with the registered provider who accepted that the records were incomplete. The registered provider has purchased induction and foundation training books which she said would be completed by newly appointed staff. Records of staff
Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 18 training were seen which demonstrate that the staff have attended certificated training courses and have received in house training but there are gaps in the training records which show that some of the staff have not received up to date training in some essential areas, such as First Aid, Manual Handling and Food Hygiene. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 Insufficient information is obtained on people employed to work to ensure that they are suitable to work with vulnerable people. EVIDENCE: A sample of staff records were seen and most of the information that is required to be kept on persons working at the home, including references, enhanced CRB checks and POVA checks, was not included. Although a sample of resident’s case records were inspected and found to be incomplete, the missing information was found elsewhere in the home. It is recognised as good practice to ensure that the staff have easy assess to records which are intended to be used as working documents, but much of this information could also be kept in a more structured format in the residents case files. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x x 1 x x 2 2 3 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 2 x Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 21 Yes 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 1 Regulation 4, Schedule 1 Requirement Timescale for action 5/8/05 2. 1 5 The Statement of Purpose needs to be redrafted and amended to include to include: the number, relevant qualifications and experience of the staff; the orgaisational structure of the home; any criteria used for admission to the home, including the homes policy and procedure for emergency admission; the arrangements made for consultation with service users about the operation of the home; the arrangements made for contact between the service users and their relatives, friends and representatives; and the arrangements made for dealing with complaints. A copy of the revised document must be sent to the Commission. (Timescale of 20/1/05 - not met). The Service Users Guides need 5/8/05 to be completed and given to each of the residents. This document must include the following: a summary of the Statement of Purpose; the terms and conditions in respect of accommodation to be provided
Version 1.30 Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Page 22 for service users, including the amount and method of payment of fees; a standard form of contract for the provision of services and facilities by the registered provider for service users; a summary of the complaints procedure; and the address and telephone number of the Commission. A copy of the Service Users Guide must be sent to the Commission. (Timescaleof 20/1/05 - not met). 3. 21 23 The hand-wash basins must be made safe to use by regulating the hot water temperature. (Timescale of 20/11/04 not met). A private lockable facility must be provided for each of the residents. (Timescale of 20/1/05 not met). As Requirement 3. Safer staff recruitement procedures must be introduced. (Timescale of 20/12/04 not met). All of the staff must received certificated training in First Aid, Manual Handling and Basic Food Hygiene. The staff records must include the following: proof of identity; evidence of relevant qualifications; two written references; and an enhanced CRB and POVA check. 5/6/05 4. 24 23 5/6/05 5. 6. 25 29 23 19 & Schedule 2 18 5/6/05 5/8/05 7. 30 5/11/05 8. 37 17, 19, Schedule 2 5/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 23 Holcombe House 1. Standard 2 2. 3. 4. 5. 21 24 29 37 The Statement of Terms and Conditions (or contract) should include the following; rooms to be occupied; overall care and services (including food) covered by the fees; fees payable and by whom; additional services to be paid for over and above those included in the fees; rights and obligations of the service user and registered provider and who is liable if there is a breach of contract; and the terms and conditions of occupancy, including period of notice. One communal bath or shower should be provided for every eight residents who do not have working en-suite baths or showers. Suitable locks, which can be overriden by the staff in the event of an emergency, should be fitted on all bed-sitting room doors. Staff should be given a statement of the terms and conditions of their employment and a copy of the GSCC Code of Conduct. The records kept in the residents case files should include their completed needs assessment, risk assessments and risk management strategies, care plans and reviews and all other information listed in schedule 3 of the Care Homes Regulations. Holcombe House D54-D07 S3722 Holcombe House V214233 190405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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