CARE HOMES FOR OLDER PEOPLE
Holcroft Grange Jackson Avenue Culceth Warrington Cheshire, WA3 4EJ Lead Inspector
David Jones Unannounced 19 April 2005 11:20am 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. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Holcroft Grange Address Jackson Avenue Culceth Warrington Cheshire WA3 4EJ 01925 766488 01925 766582 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) CLS Care Services Limited Care Home 40 Category(ies) of OP (Old Age) registration, with number of places Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No additional conditions Date of last inspection 03/12/04 Brief Description of the Service: Holcroft Grange is a care home situated in the centre of the village of Culcheth. Of single storey construction it offers accommodation, personal care and a wide range of facilities for up to forty older people. Accommodation is provided in forty single bedrooms, three of which are provided with en-suite facilities. There are three communal lounges and one dining room. A range of shops and other local facilities are within walking distance of the home and the village is supported by good public transport services. The home has good access for people in wheelchairs or with impaired mobility and there are pleasant garden areas for all service users to enjoy. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was a routine unannounced inspection carried out as part of the Commission for Social Care Inspection’s duties. The inspection took place on one day over an 8-hour period. Twenty residents, five members of staff and two visitors were spoken with during the inspection. The inspector looked at some parts of the building, inspected medication systems, looked at some records and read the case notes of four residents. What the service does well: What has improved since the last inspection?
A questionnaire had been sent to all residents to ask them about the quality of care and facilities and services provided. (The manager intends to produce a similar questionnaire to be sent to residents’ relatives and other people interested in the quality of care and services provided.)
Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 6 When all this information has been gathered the manager intends to produce a report for service users and their representatives that will say how the home has improved. All residents whose care is financed by a local authority have received documents confirming terms and conditions. All staff had received guidance on the home’s adult protection procedures including an information booklet for future reference. At least 50 of the home’s care staff team have achieved an NVQ level 2 in Care or are on an appropriate training course to achieve this qualification. 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. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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 Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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, 4 and 5. Limited progress has been made in updating the Statement of Purpose and Service Users Guide and some service users do not receive written confirmation that the home is suitable to meet their needs prior to the day of admission. Without this information service users are disadvantaged when making decisions prior to moving in to the home. No service user moves into the home without having his/her needs assessed by a competent person and service users are enabled to visit the home prior to admission to enable them to test drive the home. Service users purchasing their care privately receive a contract and those supported by a placing agency receive a statement of terms and conditions. EVIDENCE: The manager stated that work was underway to update and further develop the Statement of Purpose and Residents Guide in accordance with a recommendation made subsequent to the previous inspection of the home. See recommendation 1.
Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 9 Residents and visiting relatives spoken with, and documents seen confirmed that residents purchasing their care privately were provided with contracts and those supported by a placing authority were provided with written terms and conditions. Perusal of the case records relating to four residents confirmed that the home deployed appropriate assessment procedures involving the prospective resident and their representatives prior to admission. There was no evidence to indicate that those purchasing their care privately received written confirmation prior to admission that the home was suitable to meet their assessed needs. See requirement 1. Residents spoken with confirmed that they had been invited to visit the home prior to admission and this had enabled them to make their own assessment of the home and facilities and services provided. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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) 7, 8, 9 and 10. The home’s care planning systems are evidently based on good practice ensuring that service users identified needs are planned for. Some care plans require further development to ensure the personal care needs of the respective service users were consistently met. A multidisciplinary approach to care is fostered with evidence of appropriate liaison with health and social care professionals being made. Service users are assured that their health care needs will be addressed. Arrangements for the storage and administration of medicines were inadequate to ensure the well-being of service users. Service users are treated with respect. EVIDENCE: A sample of four residents case records was used for the purposes of case tracking. The home’s care planning processes were evidently based on good practice. Residents were involved with the development of their respective care plans and arrangements for care and support were developed in accordance with the individual’s needs, their interests and personal preferences. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 11 However, two of the four care plans seen required further development. In one instance a resident stated her dentures were loose and the Cook had provide her with a soft diet to enable to her eat her food more comfortably. The manager was not aware of these special arrangements and the care plan indicated that a special diet was not required. In another instance observation and discussion with staff indicated that a resident needs had changed in recent weeks. The residents propensity for wandering and agitation, which had previously been deemed as manageable, had become more frequent and intense and staff were presented with specialised needs that the home was not designed to meet. A referral had been made to the GP for reassessment. The assessment concluded that the resident required specialised dementia care and arrangements were being made for the resident to move to an appropriate establishment. There was no indication that the care plan had been reviewed since re-assessment to ensure that interim arrangements to meet the residents needs were adequate and to confirm arrangements for a planned discharge. See requirement 2. Residents’ health care needs were met. Residents spoken with and case records perused confirmed that the health care needs of residents were monitored and, where appropriate, effective liaison was maintained with each individuals’ health and social care advisors. An error was identified in the home’s medication records where medication which remained in the monitored dosage system was recorded as administered. Further inspection of the home’s medication storage and administration systems identified more errors in the recording of controlled drugs and deficiencies in storage facilities. See requirement 3. Residents spoke highly of the home and the standard of care received. Residents and a visiting relative gave examples of the lengths staff had gone to preserve their dignity and privacy. Staff were seen to conduct their duties in good humour. Interactions with residents were frequent and positive and the way in which residents wished to be addressed was respected. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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 and 15. The lifestyle in the home reflects the expectations and personal preferences of service users. Visitors are made welcome, the standard of catering is good and service users are enabled to access the local community on a regular basis. EVIDENCE: The atmosphere in the home at the time of the inspection was relaxed, pleasant and sociable. A visiting relative confirmed that they were made welcome and were enabled to visit their relative in private if they so wished. The home employed an activities co-ordinator and a programme of activities was posted on the notice board for residents’ information. Residents advised that a range of suitable activities were on offer including escorted outings to local community amenities; including watching Line Dancing and visiting shops. Other residents spoken with advised that they did not wish to participate in group activities preferring to knit or read in the privacy of their own rooms. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 13 The vast majority of residents spoken with stated that the standard of catering in the home was good. One resident indicated that the standard of cooking was good but some of the offerings on the menu, including “Fish fingers” were palatable but undesirable. Menus seen confirmed that a choice of meal was available at every mealtime and residents were able to choose from a range of options. Discussion with the Chef indicated that residents’ preferences, likes and dislikes were known, respected and catered for. The service user who advised that he did not find some of the offerings on the menu desirable was offered alternative dishes to his liking. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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) 16 and 18. Arrangements for the protection of service users and enabling them or their representatives to make a complaint were robust and effective. EVIDENCE: The home’s complaints procedure provided appropriate guidance and information as to how to make a complaint. Information provided indicated that no complaints had been received since the last inspection. A record is maintained in the home of all complaints made and includes details of the investigations and any action taken as a result. Robust procedures for responding to suspicion or evidence of abuse or neglect were in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. A recent adult protection investigation conducted by CLS under the auspices of the local authority’s adult protection procedures had resulted in allegations being substantiated and appropriate action taken to protect service users. Information provided by the manager indicated that all staff had received a booklet providing guidance on the implementation of adult protection procedures and have signed to confirm their understanding of the same. Further training needs identified via the home’s staff appraisal systems would be addressed in due course. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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) 19. 20 and 26. Service users live in well-maintained, comfortable, clean and hygienic accommodation with access to appropriate indoor and outdoor communal facilities. The safety of vulnerable service users was jeopardised by continuing problems with the home’s hot water system and delays in upgrading fire doors in accordance with the Fire Officers recommendations. EVIDENCE: Holcroft Grange is ideally located in the centre of Culcheth village with easy access to the local shops and general amenities. The home itself is well maintained with good quality furnishings and fittings. There is an attractive garden and inner courtyard that provides a safe area for residents to sit and relax. Residents spoke highly of the home and stated satisfaction with facilities and services provided. The home was found to be clean and hygienic. A number of residents praised the standard of cleanliness stating that this was very important to them.
Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 16 Issues regarding the health and safety of residents in relation to the provision of hot water at safe maximum temperatures and delays in implementing the recommendations of the fire officer are addressed below under the section of the report titled Management and Administration and at Requirements 4 and 5. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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 and 28. Staff were deployed in appropriate numbers and skill mix sufficient for the well being of service users. EVIDENCE: Observation and perusal of staff rosters indicated that staff were deployed in appropriate numbers, with a minimum of one Care team Leader supported by three care assistants on duty throughout the day time period. Information provided by the manager indicated that three members of the 22 strong care staff team had achieved an NVQ in care to level two or above and a further eight were working towards the qualification. When all eleven staff have attained this qualification the standard regarding at least 50 of the home’s care staff team achieving an NVQ level 2 in care will be met. Discussion with the manager indicated that CLS continue to operate a comprehensive staff-training programme that had been developed to incorporate “Skills For Care” staff training standards. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 18 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 and 38. Progress had been made in implementing the home’s quality assurance procedures and there is clear evidence that the home is run in the best interests of service users. The safety of vulnerable service users was jeopardised by continuing problems with the home’s hot water system and delays in upgrading fire doors in accordance with the Fire Officers recommendations. EVIDENCE: Progress had been made toward meeting the requirement made at the previous inspection to establish a system for reviewing and improving the quality of care in the home in accordance with the requirements of the Care Homes Regulation 24. The manager had introduced a “residents” satisfaction questionnaire and was in the process of collating the information from 20 returned questionnaires at the time of the inspection. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 19 The manger intends to develop similar questionnaires to ascertain the views of residents’ relatives and other stakeholders including associated health and social care professionals. Subsequently a report confirming action taken to improve the quality of care provided would be produced and a copy will be made available to the Commission for Social Care Inspection. Residents gave a number of examples where arrangements for their care had been improved and tailored to meet personal preferences, likes and dislikes. It was evident that residents were listened to and their wishes respected. A requirement made at the previous inspection to fit fire doors that have not already been upgraded with in-tumescent trips and smoke seals, in accordance with the recommendations of the fire officer, had been addressed in part. The work had been referred to a contractor but unforeseen delays had resulted in the work not being completed. See requirement 4. Information provided by the home services manager indicated that continuing problems were being experienced with the home’s hot water system. Action had been taken to ensure that water was delivered at appropriate temperatures at or near 43 degree C but temperatures had begun to rise again. Risk assessments had been completed on each resident but these did not take account of the varying abilities of each person and the stipulated control measures did not offer protection to vulnerable residents. A resident who had been diagnosed with a dementia and assessed as requiring specialist care was found to be at risk of scalding. Hot water temperatures in this resident’s bedroom were tested with a calibrated thermometer and found to be in excess of 52 degrees centigrade. See requirement 5. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 1 Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 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 3 Regulation 14 Requirement The registered persons must ensure that prospective service users recieve written confirmation as to the homes suitability to meet their needs prior to the date of admission. The registered persons must ensure that care plans are updated and appropriately detailed as and when service users needs change. The registered persons must ensure that comprehensive and accurate records are maintained of all medicines adminstered in the home. (Previous timescale of 03 December 2004 not met) and that medicines including controlled drugs are administered and stored appropriately and in accordance with guidance from the Royal Pharmaceutical Society. The registered persons must fit fire doors that have not been already upgraded with intumescent strips and smoke seals, in accordance with the recommendations of the fire officer. (Previous timescale 28. February 2005 not met).
F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Timescale for action 31.May 2005 2. 7 15 31.May 2005. 3. 9 13 30. April 2005. 4. 38 23 31.May 2005. Holcroft Grange Version 1.30 Page 22 5. 38 13 and 23 The registered persons must review risk assessments relating to hazards presented to service users by the presence of hot water and sunsequently take approriate action to ensure the health and safety of vulnerable service users. 30. April 2005. 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 1 Good Practice Recommendations The registered persons should develop the homes Statement Of Purpose and Service Users Guide to ensure that all required information is provided for current and prospective service users. Holcroft Grange F51-F01 S27011 Holcroft Grange V222189 190405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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