CARE HOMES FOR OLDER PEOPLE
Holcroft Grange Jackson Avenue Culcheth Warrington Cheshire WA3 4EJ Lead Inspector
David Jones Unannounced Inspection 9th November 2005 10:00 X10015.doc Version 1.40 Page 1 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 Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 2 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 DS0000027011.V264973.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holcroft Grange Address Jackson Avenue Culcheth Warrington Cheshire WA3 4EJ 01925 766488 01925 766582 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CLS Care Services Limited Pauline Shaw Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 40 service users to include: * up to 40 service users in the category of OP (old age not falling within any other category) may be accommodated. The registered manager Pauline shaw must achieve an NVQ level 4 in care by February 2006. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which be issued through the Commission for Social Care Inspection 19th April 2005 Date of last inspection Brief Description of the Service: Holcroft Grange is a care home situated in the centre of the village of Culcheth. It is a single storey building. It offers accommodation, personal care and a wide range of facilities for up to forty older people. There are forty single bedrooms, three of which have 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 DS0000027011.V264973.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on one day over a 7-hour period. Nine residents and four members of staff 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:
Holcroft Grange is ideally located in the centre of Culcheth village with easy access to the local shops and general amenities. The home provides comfortable, well-equipped and nicely decorated accommodation. It 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. The atmosphere in the home is sociable and visitors are made welcome. Residents are able to choose from a range of activities and are assisted to visit the local shops and other places of interest. The standard of catering is good. Residents say that both of the cooks are good. Choice is offered with every meal, residents’ likes and dislikes are known and catered for. The home’s assessment and care planning processes are based on good practice and involve the resident and their representatives in the continuing development of effective arrangements for care and support. Residents say that arrangements for health care are very good. Residents speak highly of the standard of care provided and are appreciative of the way staff support them on visits to the clinic and on Doctor’s appointments. Staff monitor residents’ health and well-being and make contact with health and social care professionals when required. A competent person who is supported by a dedicated team of senior staff manages the home. Staff are skilled and caring and considerate in their approach. There is an effective staff training and development programme in place and all staff are appropriately supervised. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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 DS0000027011.V264973.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 the following standard(s): 1, 3 and 5. New residents are admitted to the home on the basis of a full assessment undertaken by persons with appropriate training. Assessment and admissions procedures put the new resident and their representatives at the centre of decision-making. Residents are able to visit the home and arrangements are now in place to ensure they receive written confirmation that the home is suitable to meet their needs before they move in. This helps them to make an informed choice about the home. EVIDENCE: New residents are admitted to the home on the basis of a full assessment undertaken by persons with appropriate training. Assessment and admissions procedures put the new resident and their representatives at the centre of decision-making. They are able to visit the home and arrangements are now in place to ensure they receive written confirmation that the home is suitable to meet their needs before they move in. This helps them to make an informed choice about the home.
Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 9 Residents are positive about the home indicating satisfaction with facilities, services and the standard of care provided. One new resident who had moved in on a trail basis said that the process of moving in had been straightforward and effective. She had moved from a place far away, a placing agency had not been involved and the manager was unable to visit her to complete an assessment. However, she had spoken with the manager about her needs on the phone and the manager had confirmed the home’s suitability to meet her needs, as described. Because this resident was unable to visit the home before she moved in she asked a trusted friend to do this on her behalf. She had lived in the village of Culcheth for many years and was very happy to be back in her old neighbourhood. She had not seen the home’s statement of purpose or service users guide and she had not received written confirmation of the home’s suitability before she moved in. However moving into Holcroft Grange had been a very positive experience for this resident. The manager confirmed that a new statement of purpose and service users guide is now available and arrangements are in place to make sure that all new residents receive written confirmation as to the home’s suitability before they move in. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9. The home’s assessment and care planning systems ensure that residents’ identified and developing needs are met. Risk assessment and prevention of falls procedures must be kept under review to make sure that risks of falling are minimised. The home works closely with other health and social care professionals and residents are assured that their health care needs will be met. Arrangements for the recording and storage of medication require improvement to ensure the protection of residents. EVIDENCE: The home’s care planning processes are based on good practice. Residents are involved with the development of their care plans and arrangements for care and support are mirror the individual’s needs, interests and preferences. Four care plans were read as part of a case tracking exercise. In each case the care plan provides confirmation as to how the resident’s needs are being met and includes details of what the resident is able to do for themselves. Appropriate records are made when restrictions as to the individual’s freedom of movement or power to make decisions have been agreed. The resident or their representatives are invited to sign the care plan for confirmation.
Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 11 Risk of falls assessments are in place where required but in one instance it was noted that this was not reviewed when a resident had three successive falls. The manager was not aware of the guidance provided by the National Institute for Clinical Excellence on the prevention of falls for older people. See requirement 1 and recommendation 1. Residents speak highly of the standard of care provided and are appreciative of the way staff support them on visits to the clinic and on Doctor’s appointments. Staff monitor residents’ health and well-being and make contact with health and social care professionals when required. A number of residents said that the health care in the home is very good. As an example one resident said she was encouraged to have her eyes checked and with the assistance of a care assistant visited the Optician at the hospital. She said that it was very complicated at the hospital and she was very pleased to have someone with her to help her understand what the Optician was saying. All residents said they have privacy and are treated with dignity and respect. Appropriate arrangements are in place for the administration and safe storage of medicines with the exception that records of medicines brought into the home by new residents are not maintained in the appropriate detail and medicines to be returned to the Pharmacy are not being stored in a locked medicines cabinet. See requirement 2. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14 and 15. The lifestyle in the home reflects the expectations and personal preferences of residents and choice is promoted. Visitors are made welcome, the standard of catering is good and residents have access to a range of appropriate activities. EVIDENCE: Residents are unanimous in their praise for the home indicating that they are more than satisfied with the standard of catering, the range of activities and the lifestyle in the home. Both cooks are said to be very good. Special dietary needs are catered for and menus confirm that a varied and nutritious diet is on offer. One resident who is proud to announce that she has reached the grand age of 100 years says that “the home is good but it can’t match her own home.” However, she adds that the “staff are very kind, the food is very good and it is very comfortable. She loves to join in with the activities but often decides to knit instead. There are no rules residents can do what they want and go to bed when they like.” Residents are helped to exercise choice and control over their lives and receive assistance through the home’s care planning systems when this is needed. Another resident has learned how to use the computer and is impressed with advances in modern communication. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 13 There is an activities programme, which is the source of lively debate amongst residents and is discussed in detail at residents meetings. Some residents are looking forward to a planned trip to Bents Garden Centre. Residents are able to have visitors at any reasonable time and links with the local community are developed and maintained. The home enjoys the support of a number of volunteers who visit the home on a regular basis and engage with residents in a number of activities. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 the following standard(s): 18. Arrangements for the protection of residents are effective. EVIDENCE: Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. Staff have received a booklet providing guidance on the implementation of adult protection procedures. Further training needs identified via the home’s staff appraisal systems will be addressed in accordance with each staff member’s personal development plan. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26. Residents live in well-maintained, comfortable, clean and hygienic accommodation. Action must be taken to upgrade the fire doors in accordance with the Fire Officers recommendations and provide a safe environment for residents, staff and visitors. EVIDENCE: Holcroft Grange is ideally located in the centre of Culcheth village with easy access to the local shops and general amenities. The home 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. The conservatory is out of bounds for residents because of a leak in the roof. The manager advises that CLS property Services are aware of the problem and appropriate arrangements are being made to make repairs. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 16 Problems previously identified with the home’s hot water systems have been sorted out. The handy person continues to monitor hot water temperatures to make sure that hot water is delivered at an appropriate temperature. Record indicate that hot water temperatures range between 43Ë and 45Ë C. Issues regarding the health and safety of residents in relation to the recommendations of the fire officer are addressed below under the section of the report titled Management and Administration and at Requirements 3. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staff are employed in appropriate numbers and skill mix sufficient for the well being of residents. Thorough recruitment procedures ensure the protection of residents. Induction procedures for agency staff need improvement to make sure that all staff are sufficiently prepared to meet residents needs and appropriate records are made and maintained for the benefit of review. EVIDENCE: Discussion with staff and residents and observation indicates that staff are employed in appropriate numbers, with a minimum of one Care team Leader supported by three care assistants on duty throughout the day time period. There have been some concerns in the recent past with the high usage of agency staff. However, information provided by the manager indicates that these matters have been sorted out as the home has a full staff team. Agency staff are still used from time to time to cover holidays, sickness and other staff absences. One resident said that some of the agency staff don’t seem to bother they don’t know what to do. The manager states that there is an induction procedure for agency Care Team Leaders but this does not extend to agency care assistants. Agency care assistance are familiarised with the fire exits and the home but this is not recorded. See recommendation 3. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 18 Reading of staff files and discussion with the manager confirmed that CLS operate effective recruitment procedures. Care staff confirm satisfaction with current staffing levels and training opportunities. One spoken with advises that she completed an NVQ in care at level 2 in July 2005 and another who has been recently recruited states that she is completing a TOPSS induction workbook under the supervision of the manager. Information provided by the manager indicates that six of the 21 strong care staff team have achieved an NVQ in care to level two or above and a further five are working towards the qualification. When all eleven staff have acquired 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. See recommendation 2. Discussion with the manager indicates that CLS continue to operate a comprehensive staff-training programme that has been developed to incorporate “Skills For Care” staff training standards. Staff carry out their duties with sensitivity and skill. Staff speak with residents in a calm and clear manner and residents are afforded time to respond and are not hurried. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38. A competent person manages the home. Appropriate arrangements are in place for the handling and recording of residents’ monies. All staff are supervised as part of the normal management process and care staff have regular recorded supervision meetings with senior staff. Health and safety of residents and staff is promoted but action needs to be taken to address the recommendations of the fire officer. This will help to ensure the safety of residents and staff in the event of a fire. EVIDENCE: The manager is competent and experienced to run the home and meet its stated purpose, aims and objectives. She has a City and Guilds in Community Care a post graduate Diploma in Management Studies and is currently working towards NVQ level 4 in care and the registered managers award. Staff are appreciative of the leadership, support and direction she provides.
Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 20 Residents are able to deposit small sums of money with the home. Appropriate records are maintained. Care staff receive formal supervision at least six times a year. 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 has been referred to the organisations property services department but no significant progress has been to address the problem. There are no smoke seals on some communal and connecting bedroom doors. See requirement 3. Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 3 X 2 Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes. 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 OP8 Regulation 12 and 13 Requirement Timescale for action 31/12/05 2 OP9 13 3 OP38 23 The registered persons must review risk of falls assessments when residents’ circumstances change. The registered persons must 09/11/05 ensure that comprehensive records are maintained of all medicines administered in the home. (Previous timescale of 03 December 2004 and 30. April 2005, not met) and that all medicines including those to be returned are stored appropriately and in accordance with guidance from the Royal Pharmaceutical Society. The registered persons must fit 11/02/05 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 and 31.May 2005.not met). Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 23 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 OP8 Good Practice Recommendations The registered persons should acquire a copy of the National Institute for Clinical Excellence “Guidance for the Prevention of Falls in Older People” for the guidance of staff. The registered persons should ensure that at least 50 of the care staff team achieve NVQ in care The registered persons should improve and record arrangements for the induction of agency care staff to ensure that they are familiar with the home and the needs of residents. 2 3 OP28 OP30 Holcroft Grange DS0000027011.V264973.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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