Inspection on 10/09/07 for Holehird - Leonard Cheshire Disability

This inspection was carried out on 10th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holehird - Leonard Cheshire... 07/06/06

Holehird - Leonard Cheshire... 16/03/06

Holehird - Leonard Cheshire... 01/12/05

Holehird - Leonard Cheshire... 21/12/04

Holehird - Leonard Cheshire... 18/08/04

Holehird - Leonard Cheshire... 22/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Holehird Lake District Cheshire Home Patterdale Road Windermere Cumbria LA23 1NR Lead Inspector Jenny Donnelly Unannounced Inspection 10th & 28 September 2007 10:00 th Holehird DS0000006133.V352486.R01.S.doc Version 5.2 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 Holehird DS0000006133.V352486.R01.S.doc Version 5.2 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 Adults 18-65. 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. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holehird Address Lake District Cheshire Home Patterdale Road Windermere Cumbria LA23 1NR 015394 42500 015394 45707 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) www.leonard-cheshire.org.uk Leonard Cheshire Mr Alan Barton Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (6) of places Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 29 service users to include: up to 29 service users in the category of PD (Physical disabilities) up to 6 service users in the category of PD(E) (Physical disabilities over 65 years of age) The number of places providing nursing care must not exceed 25. Date of last inspection 7th June 2006 Brief Description of the Service: Leonard Cheshire operates Holehird. The building is a Victorian mansion, with a modern extension and is situated about two miles from the town of Windermere. It is set above the lake with beautiful views of the lake and the surrounding mountains. There is a large car park and adjacent public gardens, which are managed by the Lakeland Horticultural Society. The home has two floors served by a passenger lift, and residents’ bedrooms are situated on both floors. The communal and recreational rooms are on the ground floor. There is a physiotherapy room, and the home has been adapted with overhead hoist tracking in the majority of bedrooms and bathrooms. The manager Alan Barton had been in post since summer 2005, and is registered with CSCI. Leonard Cheshire announced in 2003 that they intended to move out of the Holehird building over the next two to three years, and provide a new purpose built home in a different location. The weekly fees at Holehird are set in accordance with each service users’ assessed care needs. The range of fees for current service users ranged from £611.57 to £1033.80 per week. Information about the home, in the form of a service user guide, could be viewed at the home or copies requested. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the main or “key” inspection of the service for this year. Since the last key inspection in June 2006 a further “random” visit was made in September 2006, the report from that visit is available on request from CSCI or from the care service. This inspection consisted of the manager completing an “Annual Quality Assurance Assessment”, and surveys were sent to 13 people who live in the care home and their relatives. Information gained from these documents is included in this report. Two inspectors made an unannounced visit to the service on 10th September. During this visit we toured the building, spoke with service users, visitors, volunteers and staff. We also examined records relating to care, staffing and management, and observed the daily life of the home. The registered manager was on holiday at the time, and we returned to Holehird on 28th September to meet with him. Our pharmacist inspector visited Holehird separately on 4th September and her findings are included in this report. What the service does well: The admission process is thorough and works well for planned long-term admissions to the home. Individual care plans are detailed and include information about people’s personal wishes and goals. The plans are kept under review, are updated as needed and fully reflect each individual’s choices and needs. The service supports residents who wish to look after and take their own medicines and this helps them remain as independent as possible. The service has arrangements for the administration of non-prescribed medication so that residents with minor ailments can receive treatment without delay and without the need to consult a doctor. There is a good provision of social care, activities and occupation for the majority of people living in the home. This is supported by a network of local and overseas volunteers, as well as paid activity staff. The service manages complaints well, responds to people who raise concerns, and is willing to learn from these and change the way they do things if needed. Any concerns about safeguarding issues are reported to adult social care for investigation, as they should be. The home is kept clean and hygienic and staff are aware safe working methods to reduce infection. The service is competently managed, and the manager has worked hard to improve morale and standards in the home. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is good information about the service available to prospective clients and the admissions process helps ensure Holehird can meet peoples’ personal, social and healthcare needs. EVIDENCE: Leonard Cheshire has a standard pre-admission assessment used to assess all potential new clients. This takes into account information from other agencies such as hospitals, social workers and healthcare specialists. The assessment process involves a senior member of Holehird staff visiting the prospective client, either in their own home or in hospital. This information is used to assess whether Holehird would be a suitable placement for the individual and to assess the fee level. There was some evidence that this system does not work quite so well with respite clients, especially where there is a long gap between the assessment and planned respite. The manager should tighten up this process. Holehird has produced good information for prospective clients, in the form of a statement of purpose and service users guide, which details the service offered and type of clients catered for. There are additional leaflets setting out Leonard Cheshire’s expected service standards and the complaints procedure. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Individual plans are drawn up with each service user and these clearly include peoples’ personal choices and evidence of decision-making. EVIDENCE: Each person has an “Individual Service Plan”, called an ISP, in place. These are drawn up with the involvement of the person and are written in a person centred way, such as, “I like to have …”. Plans were of a good standard and had been kept under review and updated as needed. Each person had been allocated, or chosen, a keyworker, who takes a special interest in their care. Plans clearly showed individuals’ wishes and choices and set out short and long term goals. There was evidence that people were enabled to make decisions about their life, and there was good information about the level of assistance people needed, and any areas of life people chose to manage themselves. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 10 Risk assessments and agreements had been completed with individuals about specific aspects of their life. These were personal to each individual rather than blanket statements, and included things such as the use of motorised wheelchairs or other specialist equipment, going out of the home/grounds alone and self-management of finances and/or healthcare arrangements. Although Holehird has very good systems for asking about and recording peoples’ individual wishes, people said staff frequently lacked the time to work accordance with these wishes. This is commented on further under the “personal and healthcare support” and the “staffing” sections of this report. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Holehird provides a wide range of activities and opportunities both within and outside of the home, for the majority of people. However, more attention is needed in supporting more dependant people to access these opportunities. EVIDENCE: Holehird employs three part time activities co-ordinators, along with a number of local and overseas volunteers, to promote entertainment and occupation for people. There was a very good amount and range of activities on offer. During the inspection we saw groups of people participating in word puzzles, ball games, reading and discussing the daily newspapers and engaging in general conversation throughout the day. There were photographs on display of various outings, boat trips, sailing and barbeques that had taken place over the summer. The home had access to three wheelchair accessible vehicles and used volunteer drivers for outings. Some people also had individual Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 12 arrangements to spend time out of Holehird at day centres or with family and friends. The home has a domestic style kitchen people can use for pleasure or occupational therapy purposes, though staff said this was very infrequently used now. There are two computers, one with broadband access, and the activity co-ordinators or volunteers help people use these if needed. Whilst some people were able to fully engage in the activities, others commented that they generally missed the morning session as they were waiting for care staff to help them get up and dressed. We did see that a number of people were not ready to come out of their rooms until lunchtime, and daily routines appeared to be governed by workload, rather than by peoples’ wishes. Some of the more physically dependent people were also seen to spend a lot of time in bed, and their care records confirmed this. There was evidence that one person had not left the home in two years, as staff felt he was “settled” and were anxious that the person might be “upset” by change. This lack of confidence and knowledge amongst staff about this condition, was limiting peoples’ opportunities to lead a more fulfilling life. We also observed that some of the overseas volunteers had very limited English language skills, preventing them from engaging fully with service users who themselves have communication difficulties. The manager said he would follow this up the recruitment agency as it had caused some difficulties recently. We received mixed comments about activities in the completed surveys from service users and relatives, which included: • “He can do as wishes within the scope of the home and is able to decided if he wants to go on trips” • “There are not the extra staff or volunteers at the weekend to do an awful lot” • “He does many trips he could not possibly do at home” • “Staff do things appropriate to his age and abilities” • “(Staff) only take them out of their room for 2 hours to my mind this is solitary confinement” • “I always miss the morning activities which I would enjoy” • “I missed a slide show I wanted to see because I was not up in time” People commented very positively on the provision of meals, saying there was always a choice and the food was very good. There were daily menus on display that showed a meat and a vegetarian option. Staff also said the kitchen were aware of peoples’ preferences and would automatically provide alternatives. We observed lunchtime, and noted that where people needed help with eating, staff did so in a patient and sensitive way that upheld the person’s dignity. One person said; “The home feeds us well”. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The standard of personal and healthcare support was mostly good, but this was inconsistent and not good enough for some people. EVIDENCE: Service user care plans set out in detail what care people need and what their individual preferences and wishes are. People commented that they were well looked after and received very good care, but that they had to wait for it, and this impacted negatively on the rest of the day and their quality if life. One person said, • “Staff are good, but there’s not enough of them, I was up early today 11am – yesterday it was 12.15, some days it is 12.45pm”. We observed a lot waiting; several people were waiting in bed to get up as we toured the building between 11 and 11.30 am, one person waited a long time to be assisted to the toilet, another person was waiting after lunch for an injection when there was a television programme they wanted to watch in their bedroom. Staff said they would have gone to the person’s room with the injection, but the person was afraid of being forgotten. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 14 The home used the services of three GP practices in the area, although the majority of people were registered with one practice, and there appeared to be little choice in this. There was evidence that people were able to access a range of healthcare including dentistry, eye tests and chiropody. For people with very complex conditions there were regular team reviews, which included physiotherapy, occupational therapy, dietician and consultant input. Holehird has a well-equipped physiotherapy department, staffed by a qualified physiotherapist and an assistant. Some people thought their healthcare needs were well attended to, others had concerns; • “I am extremely pleased with the manager, his keyworker and physiotherapist, and the OT ladies who work hard for him” • “If you are concerned about a health problem on a Friday they say we will get somebody to see to it on Monday” • “I would like to change my GP” • “The doctor was allocated to my brother, he had no choice, can this be changed to one of his choice” • “I would like to know of appointments directly from the hospital, rather than just be told by staff” • “I don’t think the staff or the doctor are very knowledgeable in this particular condition”. Records for receipt of medicines into the home and administration to residents were sometimes inaccurate. For example, the dose administered was not always recorded and records were sometimes signed when medicines were not given. Some medicines were counted and discrepancies were found. In one case a number of tablets were missing and could not be accounted for. The home needs to improve record keeping so that medicines can be accounted for and to show that residents receive treatment as intended by their doctors. Residents were supported to look after and take their own medicines if they wished and were able to, and this allowed them to remain as independent as possible. The care plan for one resident addressed self-medication but the risk assessment was inadequate and would benefit from review. The home kept a supply of non-prescribed medicines for the treatment of minor ailments that were authorised for use by residents’ doctors. This benefits residents as they can receive treatment for conditions such as minor pain without delay and without the need to see the doctor. Medicines storage was clean and tidy but the fridge was too warm for the medicines stored there and this could affect the quality and effectiveness. The trolley was not big enough to carry all medicines during the medicines round. To save on storage staff sometimes used one resident’s medication, for example paracetamol, for the treatment of other residents. The stock of nonprescribed medicines was seen that included a medicine that had previously been prescribed for a person. Medicines that are prescribed for, and are the property of, one resident must not be used for the treatment of others. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People were able to make their views and complaints known and receive a considered response from Leonard Cheshire. Staff were trained in the process for safeguarding people in their care, and people did feel safe and protected in the home. EVIDENCE: Holehird has a complaints procedure, a copy of which is handed to all service users and their relatives. People said they were aware of the procedure and knew how to make a complaint. Surveys told us; • “Any questions are dealt with before they become a source of complaint” • “If you point out something to them, they correct it” • “The sisters office and administration office aren’t signposted, I don’t know who to ask if I have a question”. There was evidence that the manager responded to complaints in line with the Leonard Cheshire procedure, and some changes are being made as a result of a recent complaint. These include a call bell for use outside, the use of “do not disturb” signs and changes to blood pressure monitoring. People were offered the opportunity to take their complaint to a higher level if they wished. There was a compliment file containing letters and cards of thanks and appreciation form past service users. Further to the last inspection, the majority of staff have undertaken training in safeguarding adults, which covers types of, and recognition of abuse and the Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 16 reporting procedures. There was evidence that allegations and incidents had been dealt with in liaison with adult social care, under the safeguarding procedures. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Holehird provides a suitably adapted environment for people with disabilities, and is kept clean and hygienic. However, some rooms have become shabby and in need of upgrading. EVIDENCE: Holehird is a grade 2 listed building both internally and externally, which complicates any planned improvements. The main building of the home has two floors served by a passenger lift, and there is a single storey modern extension to one side. The communal rooms are large and corridors are spacious and allow good wheelchair access. On the whole the building is well maintained, with an ongoing decorating programme. Some people have decorated and furnished their own bedrooms to a very high standard. One other bedroom has been recently painted and had a new carpet, and four profiling beds had been purchased. However, it is recommend that some further improvements be carried out. A number of Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 18 bedrooms have shabby carpets, old and damaged furniture and damaged paintwork. There is an old heater in the residents’ kitchen that needs removing or replacing, a light shade is missing, and the outside patio is overgrown with weeds. There are extensive grounds, which are mostly wheelchair accessible, and there are glorious views over lake Windermere to the fells. The home employs a handyman, and there are records of equipment checks and servicing of facilities. There is an on site laundry which has recently been upgraded, and there are adequate sluicing facilities. The home was clean, hygienic and fresh smelling. Staff had received training in infection control, and were aware of good practice and were suitably equipped with gloves and aprons. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Whilst the staff are highly thought of, there are not enough of them to satisfactorily meet peoples needs, and recruitment procedures are not robust enough. EVIDENCE: Leonard Cheshire provides good training for staff through its regional training managers, records of this training are however difficult to access. Information in staff files is outdated, showing certificates from 2004 and 2005. The manager can access a computerised training database, but there were no dates listed under some subjects (moving and handling) and other dates showed in red, which the manager thought meant they were overdue. Staff were uncertain of what training they had received. There needs to a simpler system for the manager to keep track, and demonstrate who has received what training and when. All new staff undergo disability awareness training and a thorough induction programme. There had been some specialist training, including a two-hour introductory talk on Huntingdon’s Disease, but staff and the residents affected Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 20 by this condition would benefit from further training. Out of the 24 care staff employed, 10 (41 ) have a National Vocational Qualification (NVQ) in care and 9 (37 ) are working towards this, which is good. Staffing levels were a great cause for concern amongst staff, residents and visitors. The manager said he would like to provide 8 staff in the morning and 5 in the afternoon, but said due to recruitment problems this is not always possible. On the day of inspection two care staff were responsible for getting up eleven people, many of whom had very complex needs and took a lot of time to care for properly. The pressure on staff to manage such a heavy workload leads to some people spending a lot of time in bed, which is not necessary for any medical reason. Although people were very complimentary about the staff and the care they eventually got, waiting was a real concern. Comments received included; • “Staffing shortages can be a problem” • “The luxury of more staff would be an improvement for staff and patients” • “My only experience is of the response time once the alarm button has been pressed, no one came and I had to go looking for someone” • “Staff are too stretched, not enough of them” • “Our workload is very heavy...it takes all morning to get people up” • “We are very short of carers, and simply cannot meet peoples’ complex needs”. The service had thorough recruitment procedures in place for vetting new staff. However, the company policy of engaging new staff prior to gaining sight of their criminal records bureau disclosure (CRB), and dealing with any problems arising from the CRB afterwards, continues to cause disruption and concern. Although new staff are said to be supervised at all times, it is not possible for staff to always be watched and accompanied due to the busy nature of the home and the staffing shortages. Staff recruitment procedures do not fully protect vulnerable people from having potentially unsuitable staff working in the home. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service is competently managed and takes into account the views of service users. EVIDENCE: The manager, Mr Alan Barton, is suitably qualified and is registered with the Commission for Social Care Inspection. He has been in post at Holehird since summer 2005, and is well supported by Leonard Cheshire. Since coming into post Mr Barton has worked hard to improve morale in the service, stabilise the staff team, improve the quality of residents care plans and he has co-operated well with CSCI inspectors. Some of the areas where there is a shortfall in standards are not down to lack of expertise or effort by the manager. There is a staffing shortage, which he has tried to address Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 22 locally without much success, and some internal systems, such as staff training records being managed externally from the service, are holding him back. The home has a quality assurance system in place, which includes annual surveys and self audits. Through these manager can target any highlighted areas of weakness and know whether improvements made in the past have been sustained. The system also enables people who live in the home to put forward their views and suggestions. A system of staff meetings and memos helps staff keep abreast of new information and planned changes to working practice. The manager provided information to show that the building and its’ facilities were checked and serviced regularly, and there were detailed health and safety procedures in place to protect residents and staff from harm. Staff training records were difficult to access, so we could not establish if health and safety training such as moving and handling training was up to date (see staffing section). Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 3 X 3 X X 3 x Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 24 No 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 YA20 Regulation 17(1) Requirement Timescale for action 31/01/08 2 3 YA20 YA33 13(2) 18 (1) 4 YA34 19 Records for receipt, administration and disposal of medication must be accurate and complete so medicines can be accounted for and to show they are given as prescribed. Medicines that are prescribed for 31/01/08 one resident must not be used for the treatment of others. Staffing levels must be sufficient 31/01/08 to support service users assessed needs at all times, so that people are not waiting unduly to receive their daily care. Staff recruitment procedures 01/12/07 must be robust and protect service users from having unsuitable persons working in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Holehird Refer to Good Practice Recommendations DS0000006133.V352486.R01.S.doc Version 5.2 Page 25 1 Standard YA2 2 YA14 3 YA16 YA18 4 YA19 5 6 7 YA20 YA20 YA24 8 YA32 9 YA35 It is recommended that the assessment process for people coming to receive respite care be strengthened so it is clear whether the service can adequately meet people’s needs at that time. It is recommended that more attention be given to providing stimulation, activities and occupation to some of the more dependant people living in the home, to enrich their lives. It is recommended the daily routines of the home be based around people’s choices on how and when they receive support, so people are not waiting unduly for care and missing out on other activities. It is recommended that the service support people to have some choice in which doctor they register with, so people feel comfortable and confident about their healthcare arrangements. It is recommended that assessments of residents who look after and take their medicines be reviewed to show that all risks are identified and managed. The temperature of the medicines fridge should be adjusted to make sure it works at the right temperature so that the quality of medicines stored there is not affected. It is recommended that the worn carpets, shabby furniture and damaged paintwork in some areas of the home be replaced or repaired, to improve the environment people are living in. It is recommended that staff receive training in the specific conditions service users have, so they can gain specialist skills to manage care, communication and behaviour needs. It is recommended that all staff training that has taken place, or is due to take place, can be evidenced in the care home. Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Holehird DS0000006133.V352486.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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