CARE HOMES FOR OLDER PEOPLE
Holcombe House Butterton Lane Moretonhampstead Newton Abbot TQ13 8PW Lead Inspector
Judy Hill Announced 5 October 2005
th 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 V241970 051005 Stage 4.doc Version 1.40 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 V241970 051005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 4th May 2005 Brief Description of the Service: Holcombe House is registered to provide accommodation and care for up to twenty-one people (men and women) who are over sixty-five and who may have dementia and/or a physical disability. The home is situated on the outskirts of Mortonhampstead and has spectacular views over Dartmoor, but it is within walking distance of the town centre. Most of the bedrooms 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 V241970 051005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and was carried out by one inspector from 10am to 3.45pm on Wednesday 5th October 2005. The information contained in this report was gained in conversation with the registered owner/manager, the staff on duty and eight residents. Additional information was gained from a partial inspection of the premises, from direct and indirect observation and from documentary records including the Statement of Purpose/Service user guides, assessments and care plans, menu plans and staff records. What the service does well: What has improved since the last inspection?
Service users are now being given copies of the Service Users’ Guide. More formal staff recruitment procedures are now being used to ensure that only suitable staff are employed to work with the residents. Enhanced CRB checks are now being commissioned for new staff and for some existing staff.
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 6 Methods of identifying the staffs training needs have improved but there are still gaps in training provision. The record keeping is becoming better organised. What they could do better:
The homes Statement of Purpose has been amended since the last inspection but further amendments are needed to ensure that current and prospective residents and their representatives have all the information they need about the Holcombe House and the service provided. To ensure that the staff are able to use the residents individual care plans, these documents need to be more detailed and need to include risk management strategies. All of the staff should be given training on adult protection and abuse to ensure that they can identify situations that may be abusive and take appropriate action to safeguard the residents. The staff should also have access to written policies/procedures on how to deal with aggression that may be directed towards them. The home is set in extensive grounds but only a small balcony is available for the residents who may be at risk of wandering to use safely without an escort. A larger safe area of garden should be provided to ensure that the residents can go out of the home when they want to and to enable them to enjoy the spectacular setting of this home. Although some of the bedrooms have en-suite bath and/or shower facilities most of these have been capped and cannot be used. An additional communal bath or shower is needed to bring the ratio of bath/shower facilities to one for every eight residents. Several plugs have been removed from hand wash basins to prevent flooding so the temperature of the hot water needs to be regulated at a level whereby the residents, staff and visitors can wash their hands thoroughly, comfortably and without the risk of scalding themselves. Private lockable facilities must be provided for each resident so that they can store their valuables safely and subject to a risk assessment, suitable locks, which can be overridden by the staff in the event of an emergency, should be fitted to bedroom doors. Enhanced CRB checks must be carried out for all staff. A more systematic approach needs to be taken with regard to staff training to ensure that all of the staff have up to date training in health and safety related topics and in specialist areas, such as dementia care. Staff should be given copies of the terms and conditions of their employment and copies of the GSCC Code of Conduct. Risk assessments need to be carried out on all working practices to ensure that they are safe.
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 7 A quality assurance/quality monitoring system needs to be introduced to gain feedback from the service users, staff and other stakeholders about the quality of the care provided and areas where the service could be improved. 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 V241970 051005 Stage 4.doc Version 1.40 Page 8 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 V241970 051005 Stage 4.doc Version 1.40 Page 9 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 The Service Users’ Guide/Statement of Purpose is clearly written and informative but some additional information is needed to ensure that prospective residents have all of the information they need to make an informed choice about where to live. EVIDENCE: The Service Users’ Guide has been updated since the last inspection and a copy was given to the Commission. The Statement of Purpose is included in the Service Users’ Guide. This document is well written and informative but needs to be further amended to include the following: • • • Arrangements made for consultation with the residents about the operation of the care home. The fire precautions and associated emergency procedures in the care home. Reference to how the residents will be involved in their care planning and reviews.
D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 10 Holcombe House A contract/agreement is included in the Statement of Purpose and this had been amended since the last inspection to include all of the information required. A sample of the residents individual needs assessments was inspected. This demonstrated that the service provider is carrying out her own assessment in addition to the assessments carried out by Social Services (where applicable). Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 11 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) 7 & 10 The information that is included in the residents care plans is good, but not detailed enough to ensure that the care staff know and can meet their individually assessed needs. The residents’ benefit from having their privacy and dignity respected. EVIDENCE: An inspection of a sample of the residents’ assessments and case notes identified that the needs of the individual residents are being identified by the owner/manager. However, not all of this information is being used to formulate detailed care plans that can be used by the staff to inform service delivery. It was also observed that risk assessments are not being carried out routinely and that where risks had been identified, no risk management strategies had been developed to instruct the staff on ways of working to reduce risks. The privacy and dignity of the residents is respected. The staff have been instructed to knock on residents doors and give them time to respond before entering their bedrooms. Thirteen of the bedrooms are single rooms and if residents are sharing a room screens are provided to ensure that there privacy can be respected. Clothing is discretely marked to ensure that the residents always wear their own clothing. The owner/manager said that each of the
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 12 residents preferred terms of address is recorded and used and this was confirmed by one of the residents who said that she did not like her first name and that the staff and other residents addressed her by her ‘nickname’ which she did like. A cordless telephone is provided if residents wish to make or receive calls in private and arrangements will be made for residents to have private telephone lines installed (at their own expense) if they wish. Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 13 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) 15 The residents enjoy well-prepared and well-balanced meals. EVIDENCE: Copies of menu plans were sent to the Commission with the pre-inspection questionnaire that had been completed by the owner/manager. These show that four weekly menu plans are used in rotation. The main meal of the day is served at lunchtime and consists of a main course, which is usually a traditional dinner with meat, potatoes and two vegetables, followed by a pudding. The residents are not offered a choice of meals at lunchtime, but alternatives will be offered if a resident does not want the set meal. Choices are offered at breakfast time and for the evening meal. Meals are cooked on the premises and special medical diets are catered for. At the time of this inspection the home was catering for four residents who are diabetic. The home has recently purchased ‘thick and easy’ moulds, which are designed to make pureed food look like ordinary and identifiable meals. The quality of the meals provided was discussed with some of the residents who said that they were always very good. Standards 12, 13 and 14 were assessed as met at the last inspection and were not inspected in depth on this occasion.
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 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) 16 & 18 The complaints procedure is good and the residents and their representatives can be confident that their complaints will be listened to, taken seriously and acted upon. One member of staff has received very good training on adult protection and abuse, but all of the staff need similar training to ensure that the residents are adequately protected. EVIDENCE: A copy of the homes Complaints Procedure is included in the Statement of Purpose/Service Users’ Guides. The Complaint’s Procedure makes a commitment to take complaints seriously and to respond to them within twenty-eight days. The home has a copy of the ‘Alerter’s Guide’ but does not have a copy of the DHS ‘No Secrets’ video. One of the senior care assistants, who is completing her NVQ in Care at Level 3 and had completed a module on the subject, demonstrated that she has a very good understanding of what could constitute abuse. The owner/manager, who assessed the module, also said that she had learned a lot from it. However, most of the staff have not received training in abuse or adult protection. There are policies and procedures in place on adult protection and the prevention of abuse but an additional policy needs to be developed to provide guidance to the staff on how to deal with incidents of aggression that may be directed towards them by residents.
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 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) 19, 21, 24 & 25 The home is well located, well decorated and comfortably furnished and provides a pleasant and homely environment for the residents. The location of the home is ideal for people who enjoy the countryside, but the residents would benefit from better access to a safe area of garden. EVIDENCE: The home is situated on the outskirts of Moretonhampstead but is within walking distance of the town centre. Spectacular views of Dartmoor can be seen from the some of the rooms. Although the home is set in fifteen acres of private land, there is only a small balcony to provide a safe outdoor area for residents who may be at risk of wandering to use unescorted. The areas of the home that are used or occupied by the residents were seen to be clean, attractively decorated and comfortably furnished. There are thirteen single and four double bedrooms. Nine of the bedrooms have en-suite toilet facilities. Several rooms formerly had en-suite bathrooms but the baths have been capped and so are no longer in use. There are two communal bathrooms, which is insufficient for twenty-one residents. The home has a private water supply and the water is tested for impurities every
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 16 six months. The owner/manager said that the temperature of the hot water to the baths is regulated to ensure that it is not hot enough to scald residents but the hot water to the hand basins is not regulated. As some of the plugs have been removed from basins to prevent accidental flooding, valves should be fitted to hot water taps to ensure that the water is not to hot for residents, staff and visitors to wash their hands thoroughly under the taps. The residents’ bedroom doors have not been fitted with locks and either suitable locks, which can be overridden by the staff in the event of an emergency, should be fitted or risk assessments should be carried out to justify their lack of provision. Residents to not have lockable storage facilities in their rooms in which to store their money and other valuables and these should be provided. Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 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) 29 & 30 The residents benefit from being cared for by an experienced staff team who work well together. The staffing levels are good and the staff are popular with the residents. A more systematic approach needs to be taken with regard to staff training to ensure that their skills are kept up to date. EVIDENCE: The staffing levels are set at a level that is high enough to meet the assessed needs of the residents. The staff turnover is low and the staff who were spoken with or observed during the inspection interacted well with the residents. Several of the residents spoken with made very positive comments about the staff. The homes recruitment procedures were checked against the information gained when the most recently appointed member of staff was employed. She had completed an application form and written references were seen on her file, along with photocopies of documents to prove her identity. An Enhanced CRB check had been sent for. The owner/manager said that she had given the new member of staff a job description but that she had not finished drafting her terms and conditions of employment/contract. Copies of the GSCC Code of Conduct have not been given to the staff. A professional induction programme (Mulberry House) was being used. It was observed from the pre-inspection questionnaire that had been completed by the owner/manager that some of the staff have not had CRB checks. Enhanced checks must be carried out for all staff. The provision of staff training has not been given a high priority and no evidence was seen that
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 18 the staffs individual and collecting training are being have been identified or met. It was, however, noted that four members of staff are doing their NVQ at Level 2 in Care and that one of the senior care assistants have nearly completed her NVQ at Level 3 in Care. Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 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) 33, 35, 37 & 38 The care provided is good but the introduction of a quality control system would ensure that the residents and other stakeholders are able to contribute the service development. Most of the recommended record, policies and procedures and safeguards are in place and are good, but some additional work is needed to organise the paperwork and to ensure that staff have access to the information they need. EVIDENCE: There are no quality assurance or quality monitoring systems in place. The home does not handle the residents’ money. Residents who need help are asked to arrange for their families or Social Services assistance. This is recognised as good practice. The pre-inspection questionnaire and conversations with the owner/manager identified that regular maintenance of the homes services and appliances are
Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 20 being carried out. Clinical waste is removed under contact with a professional company. COSHH assessments were seen regarding the control and use of domestic chemicals. Risk assessments need to be carried out for all safe working practices. All accidents and incidents are recorded. Most of the required and recommended written policies and procedures are in place, but additional written policies are needed on Aggression towards staff and Pressure Relief. Evidence also needs to be provided that the staff are familiarising themselves with the policies and procedures. Most of the records that are required to be kept at the home are being kept although the record keeping could be better organised. Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 21 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 2 x x 2 2 x STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 1 x 3 x 2 2 Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 22 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 The Statement of Purpose must be amended to include the following: arrangements made for onsultation with residents about the operation of the care home; the fire precautions and associated emergency procedures in the care home; and, reference to how the residents will be involved in their care planning and reviews. As part of the care planning process, risk assessments must be carried out risk management strategies must be drawn up for the staff to follow to minimise any identified risk. The residents individual care plans must be more detailed and by the staff with the risk management strategies to inform service delivery. All of the staff must receive training on adult protection and abuse and this should include training on how to deal with aggression from service users. An area of garden that is suitable for, and safe for use by, residents must be provided. Hand wash basins must be made Timescale for action 5.12.05 2. 7 12 & 13 5.12.05 3. 18 18 5.4.06 4. 5. 19 21 23 23 5.4.06 5.11.05
Page 23 Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 safe to use by regulating the hot water temperature or providing plugs. (Previous timescales 20/1/05 & 5/6/05 not met). A private lockable facility must be provided for each of the residents. (Previous timescale s 20/1/05 & 5.6.05 not met). As requirement 5 Enhanced CRB checks must be carried out for all persons working at the home. The staffs training needs need to be identified, met and recorded. This training must include Basic Food Hygiene, First Aid, Fire Safety, Manual Handling, Health and Safety and Adult protection and training that is specific to the service users needs, such as dementia care. As requirement 8. 6. 24 23 5.11.05 7. 8. 9. 25 29 30 23 17 & 19 18 5.11.05 5.12.05 5.1.06 10. 11. 37 38 17 & 19 13, 17 & 23 5.12.05 Risk assessments must be 5.1.06 carried out on all working practices to ensure that they are safe. Also additional policies and procedures need to be developed to provide guidance to the staff on how to deal with aggression towards them and on pressure relief. 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 21 Good Practice Recommendations One communal bath or shower room should be provided for every eight residents who do not have functioning enD54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 24 Holcombe House 2. 24 3. 4. 29 33 suite bath or shower facilities. Suitable locks, which can be overriden by the staff in the event of an emergency should be fitted to the residents bed-sitting room doors, unless it can be demonstrated through a risk assessment that this provision would not be safe. Staff should be given a statement of the terms and conditions of their employment and a copy of the GSCC Code of Conduct. A quality assurance/quality monitoring system should be introduced to gain feedback from the residents, staff and other stakeholders about the quality of the service provided and to involve them in the ongoing development of the service. Holcombe House D54-D07 S3722 Holcombe House V241970 051005 Stage 4.doc Version 1.40 Page 25 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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