Inspection on 16/03/06 for Holehird - Leonard Cheshire Disability

This inspection was carried out on 16th March 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holehird - Leonard Cheshire... 10/09/07

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

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 16th March 2006 3:30 Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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.V283525.R01.S.doc Version 5.1 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.V283525.R01.S.doc Version 5.1 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 Vacant Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (6), Physical disability (23) of places Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of places providing nursing care must not exceed 22. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection by 30th September 2004 1st December 2005 Date of last inspection 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 last summer, and had applied to be 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. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors and took place between 3.30pm and 9pm. The manager was on duty when we arrived, and stayed for the duration of the inspection. A Leonard Cheshire senior roving manager, Jan Phillips, was also present. It was a very cold and snowy day. The inspection comprised of meeting with the manager, touring the building, reviewing care plans and staffing records, and inspection of medicines records. We spoke with residents and staff, both privately in bedrooms and in small groups in the communal areas. The evening meal was observed, after which most residents returned to their rooms leaving the home very quiet. There were 24 residents in occupancy, and 5 vacancies. What the service does well: What has improved since the last inspection? What they could do better: Further to the last inspection improvements are still needed in the following areas. The content of individual plans remained poor, with some essential information missing. The provision of and access to personal development and education continued to be poor. The home could also make better use of its current facilities to promote and maintain residents’ independent living skills. The key worker system needs further work to ensure residents benefit form the system. The manager has not yet attended adult protection training. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 6 New areas highlighted for improvement are: The system of medicines being dispensed by nurses for care staff to administer is bad practice and must cease. The records for the administration of controlled drugs were not accurate and must be. Greater care needs to be taken with the care and maintenance of residents’ equipment. One first floor bathroom and toilet are in need of repair. 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. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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.V283525.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents needs were carefully assessed prior to them being admitted to Holehird, but once in the home these needs were not necessarily being met. EVIDENCE: Leonard Cheshire has a set format for the pre-admission assessment of prospective residents. This is used in conjunction with information gained from others, including social workers and family members. There were individual plans, called “Individual Service Plans” (ISP’s) for each resident. These were lacking in basic information, and are reported on in more detail under standard 6 of this report. Residents health needs had been assessed by the primary care trust. Banding for registered nursing care contributions were set accordingly. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 Individual plans continued to lack essential information, and failed to fully demonstrate some residents’ preferences and choices about their lives. EVIDENCE: Requirements were made at the last inspection to improve individual plans (ISP’s), and allow residents greater opportunities to make decisions about their lives. Although work had been done with individual plans (ISP’s) in the form of reordering and colour coding the Leonard Cheshire standard documentation, the content of plans remained poor. The plan of one resident (identified at the last inspection in December) had been updated in February. Another plan had blank pages for personal care including continence, mobility, eating, communication, social interests and medication. Information on dependency and skin care was dated August 2005. This resident had a severe pressure sore requiring daily dressings, which was not recorded in the plan. The information relating to the wound was found, held separately from the plan, but did not give sufficient detail of the wound, the treatment and it’s Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 10 progress. There was evidence that the wound care specialist from the local hospital had been consulted for advice. Others plans lacked information about weight loss, continence management and pain management, despite these being of primary importance to the residents concerned. Further to the last inspection, Leonard Cheshire had placed one of their roving managers at Holehird for the next month, to provide support in improving individual plans. This person had arrived at Holehird on the day of inspection, so had not yet begun this task. The manager said a joint care review meeting had been held recently for one resident. There was no record of the content or outcome of this review in the person’s plan. Many residents felt they were in control of their lives and had choices in how they lived. Others who were bed bound or generally more dependant on staff, felt constrained. There was little evidence in the individual plans of residents’ preferences and choices being recognised. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 15 and 16 There were limited opportunities for residents to access personal development and education within the local community. Opportunities to develop independent living skills within the home were not maximised. Family and friends were encouraged to visit and remain part of residents’ lives. EVIDENCE: Requirements were made at the last inspection to improve residents’ access to personal development, education and occupation. While in-house activities and drives out were on offer, there was still no formal programme of development, education and occupation for younger residents. The manager stated that Holehird had difficulty accessing local services such as the college or library for residents with disabilities and behaviour issues. Some residents made use of computers, either their own, or the residents communal computer. One resident stated the person who assisted with using the computer, had not been available for some time. Satellite television was provided in the communal lounge, but as Holehird is a listed building, residents occupying bedrooms in the main house, could not Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 12 have a satellite dish for their own private use, and digital television is not yet available in the area. This reduced choices for one resident. Holehird operated an open visiting policy, so residents could have visitors at any time suitable to them. Friends and family were encouraged to visit and to be involved with activities, at the residents’ wishes. Residents’ felt their rights were protected and that staff mostly treated them with respect. There were some comments that “some staff are better than others”, “it depends who you ask”, and, “they are a bit lackadaisical at times”. Staff were heard to be civil and friendly to residents during the inspection. Residents’ individual plans did not specify any responsibilities for housekeeping tasks, although Holehird provided a domestic style kitchen and laundry. This facility could be much better utilised as part of a regular structured programme, in promoting and maintaining residents’ independent living skills. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The oversight and care of residents’ equipment needs to be improved. The management of medicines was poor, and left residents vulnerable. EVIDENCE: Requirements were made at the last inspection to improve the provision of suitable equipment for residents, and for the disposal of medicines to be properly recorded. A recommendation was made to improve the key worker system. The manager said the care supervisor was working on improving the key worker system, but she was not present. The manager said some residents did not want a key worker, and others were being re-allocated. The list was not available, so this will be followed up next time. A new wheelchair seat cushion had been provided for a resident identified at the last inspection. The manager had initially had responded to this requirement by stating the resident had spoiled the cushion through a continence problem, then that staff had spoiled it by putting it in the washing machine. The homes’ manager and staff need to be more pro-active in accessing and caring for the equipment needed by residents. Expensive battery powered wheelchairs were seen left in the corridors, not being charged up and with soiled seat covers. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 14 Further to the last inspection, two staff were now signing for the disposal of medicines. A full inspection of the medicines did not take place on this occasion, although two areas of poor practice were seen. The controlled medicines register showed a drug due to be given once, being signed out twice in the same day, with the latter entry timed before the first entry. This indicates that staff are not following the strict procedures for the safe administration and recording of controlled medicines. The manager was not aware of this particular entry in the register and agreed to look into it. Secondly, nurses were putting medicines into pots on the supper trays, for care staff to deliver to residents. This is known as “secondary dispensing” and is very poor practice. Unless residents are managing their own medicines, the nurse must administer medication directly to the resident and then record it has been administered, or explain why not. The current practice means nurses are signing to say medicines have been administered, when they may not have been, or may have been given to the wrong person. Residents do not have the opportunity to see the nurse during the medicine round, to request “as required” medicines such as pain relief or laxatives, or to ask for any other information. Neither does the nurse on duty see the resident at that time to assess their condition or check on their general well-being. The manager initially wished to defend this practice. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The manager is recommended to attend adult protection training. Leonard Cheshire have a clear complaint procedure in place, should residents wish to use it. EVIDENCE: At the last inspection the manager was recommended to attend adult protection training. This was initially planned for January, but has been delayed by Leonard Cheshire until April. Two complaint investigations have been ongoing in the home. In response to a complaint about care practices, which went through the three stages of Leonard Cheshire’s complaint procedure, and was upheld, new procedures have been put in pace. These relate to closer monitoring of residents who are ill and have high temperatures, recording of fluid intake and urine output for monitoring hydration, and competence assessments of staff assisting residents with swallowing difficulties. There was evidence that these issues had been given high priority at Holehird, through staff meetings, memos and written procedures on display around the building. A recent complaint could not be investigated, as the complainant would not meet with Leonard Cheshire’s complaint investigator, although this person was quite independent from Holehird. The commission for social care inspection did not take up this particular issue, as it did not fall within our regulatory remit. The complainant’s social worker however was involved, and the resident concerned has since left Holehird. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Holehird provides spacious accommodation in a very beautiful setting, but public transport and local amenities are difficult to access. One bathroom and toilet was in need of repair. EVIDENCE: Holehird comprises of an old mansion style two-storey house, with a modern single storey extension to the side. There is disabled access, doors with automatic opening for wheelchair users, lifts and overhead hoists in bathrooms and some bedrooms. Bedrooms vary from 12.5 to 31 sqm, and there is plenty of open communal space, and wide corridors for easy wheelchair access. The national minimum standards recommend that homes for younger adults be organised so that no more than ten people share a staff group, a dining area and other common facilities, by April 2007. Leonard Cheshire has long term plans to move out of Holehird, and provide alternative accommodation elsewhere. No recommendation is made on this standard as yet. The home is somewhat remote from the town of Windermere, and does not have good public transport links. Travel to and from the home has to be specifically arranged in advance, for both residents and staff. As mentioned in Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 17 the “Lifestyle” section of this report, residents have difficulty accessing local amenities. The general upkeep of the premises was reasonable with some decorative improvement works done over the last two years. One bathroom and one toilet on the first floor were in a poor state, with damaged bath panels and rusty toilet bars. These need to be repaired or replaced. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34 The staff team had meetings to promote communication, and there was a management on call system to support staff. Recruitment procedures had improved, with references being taken up for new employees. EVIDENCE: Concerns were raised at the last inspection that the manager and care supervisor did not work outside of office hours, and were not available to the night staff. A requirement was made for the home to ensure consistency of skill mix. The manager said he did visit the home out of office hours and had recorded one evening visit. The care supervisor was said to work 18 hours a week in a “hands on” role, with the reminder as office time, and that she met with night staff most mornings. The nurses, care supervisor and manager took turns to be “on call” for emergencies, and there was information for staff on what constituted an emergency. A staff meeting had taken place recently, and the minutes from this were available. At the last inspection, references were missing from staff files. At this visit the files of two new care staff showed satisfactory references had been obtained. Further to a previous recommendation about the role of volunteer staff, volunteers are now assessed as competent before assisting residents with eating and drinking. The manager is also renewing the volunteer list, as some Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 19 visitors who previously stated they were Holehird volunteers, were not recognised as such by the manager, but as personal visitors to one resident. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The home operated a quality assurance system, based on residents’ views. EVIDENCE: At the last inspection, satisfaction surveys were about to be sent out to residents, as part of the homes’ quality assurance programme. There were 24 residents in occupancy, and 9 questionnaires were returned. The results of the survey had been collated and were available for inspection. The overall rating given by residents was; 44 said the service was excellent, 22 said it was good and 33 said it was satisfactory. Due to the small number of completed questionnaires, each resident response counted as 11 , and the manager felt this was not true representation. The manager had applied for registration with the commission for social care. There was a delay in processing his application, as one required document was outstanding, and had been re-applied for. The requirement to have a registered manager must remain on report, until the process is complete, although it is acknowledged that the delay is not within the managers’ control. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 21 Further to a previous recommendation, residents have received written information from Leonard Cheshire about the future plans for Holehird. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 22 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 2 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X X X LIFESTYLES Standard No Score 11 1 12 1 13 X 14 X 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X X X 3 X X X X Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 23 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 YA6 Regulation 15 Requirement Residents’ care plans must be fully complete and up to date. (Previous timescale of 01/03/06) not met) Records of placement review meetings must be held on residents’ files, detailing the content and outcome of the review. Residents’ must be able to make decisions about their lives, and have opportunities for personal development and education. (Previous timescale of 01/03/06) not met) Residents’ equipment must be cared for and properly maintained. Records for the controlled drugs must be completed accurately. Nurses must not secondary dispense the medicines. The bath and toilet (as DS0000006133.V283525.R01.S.doc Timescale for action 01/05/06 2 YA6 15 01/05/06 3 YA12YA11YA7 12 (2) 01/05/06 4 YA19 13 01/05/06 5 YA20 13 (2) 01/05/06 6 7 Holehird YA20 YA24 13(2) 23(2) 01/05/06 01/07/06 Version 5.1 Page 24 identified during the inspection) must be repaired. 8 YA37 8 and 9 The home must employ a suitably qualified and experienced manager, who is registered with CSCI 01/05/06 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. 2. 3. Refer to Standard YA18 YA16 YA23 Good Practice Recommendations The key worker system should be more effective. Better use should be made of the homes’ domestic kitchen and laundry equipment to promote residents’ independent living skills. The manager should attend protection of vulnerable adults training. Holehird DS0000006133.V283525.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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.V283525.R01.S.doc Version 5.1 Page 26 - 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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