CARE HOME ADULTS 18-65
Holgate House Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP Lead Inspector
Jane Craig Unannounced Inspection 1st March 2006 11:30 Holgate House DS0000009645.V280472.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 Holgate House DS0000009645.V280472.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. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holgate House Address Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP 01200 445200 01200 415974 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) Holgate House Limited Miss Zoe Louise Ingham Care Home 7 Category(ies) of Past or present alcohol dependence (7), Past or registration, with number present drug dependence (7) of places Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2005 Brief Description of the Service: Holgate House is a small unit offering rehabilitation for up to 7 people with a history of drug and/or alcohol dependency. The treatment approach at Holgate House is person centred counselling and cognitive therapy based on the 12step philosophy. The home is situated on the edge of the forest of Bowland, within walking distance of the small village of Gisburn. There are a few shops and a local bus service in the village. The house has a mix of single and shared bedrooms. Communal rooms include a large lounge, a dining room, a group room and a domestic size kitchen. Other counselling rooms are available in an adjacent building. Holgate House stands in large grounds with patio areas and a covered area housing a table tennis table. A large garden across the lane provides space for badminton and football. There are ample car parking spaces. Holgate House DS0000009645.V280472.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 over half a day. The previous statutory inspection was done on 14th September 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of the inspection 7 residents were accommodated in the home. The inspector met with 6 of the residents in a group situation. The residents talked about their experiences of staying at the home and their rehabilitation programmes. Their views and comments form part of this report. Discussions were held with the owners of the home, the registered manager and a member of staff. A tour of the premises took place and a number of records and documents were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well:
Residents were involved in all aspects of planning their care. Staff encouraged them to set their own goals and review their progress. Staff helped residents to identify and manage risks within a safe environment. Residents said that being able to take risks helped to stop them being over protected. One resident said “we have to look at every angle,” and another said, “it helps when we get back into the real world.” Residents said that although there were some strict rules in the home, they had enough freedom and choice. One said, “I’ve never been in such a well balanced place.” Another said, “We take more responsibility for ourselves as time goes on.” Residents said that their day was very structured but there was time built in for leisure activities and free time in the evening. Residents were happy with the environment and said they felt comfortable and relaxed there. One said, “it’s a fantastic place to recover,” and another said, “it’s homely, you don’t feel as if you are in an institution.” Staff and residents got on well together. Residents said the staff were polite and respectful and one said, “you genuinely feel they do care about you.” Residents also said that staff were “really good at what they do,” and “very professional.” The manager made sure that background checks were carried out on staff before they started work at the home. This provided safeguards for residents. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 6 Residents said that they had lots of opportunities to tell the manager and staff what they thought about the service. One resident said that they could talk about anything in the group meetings and another said, “if we raise things at meetings they get sorted out.” 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. Holgate House DS0000009645.V280472.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 Holgate House DS0000009645.V280472.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): EVIDENCE: None of the above standards were assessed during this inspection. Standards 1, 2 and 5 were assessed and met during the inspection of 14/09/05. Holgate House DS0000009645.V280472.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 9 Residents were involved in setting their own goals, and care plans provided staff with sufficient information about treatment approaches. Residents were supported to identify and manage risks as part of their treatment plan. EVIDENCE: Care plans followed the 12 step programme and identified treatment approaches to be used. Residents completed their own assessments and treatment goals, which they discussed and agreed with their individual counsellor. Progress towards meeting goals was discussed every week in a group situation. The group then helped the resident to set further goals. Residents were responsible for writing their own plans and notes. Other needs, such as ongoing healthcare needs, were addressed on separate plans. These plans did not always provide staff with clear directions as to the type and level of support the resident needed. There was a detailed policy with regard to risk taking. As part of their treatment programme residents were encouraged to identify the potential risks involved in any activity they did. The group discussed the risks and made suggestions as to how they could be minimised. Ultimately the resident made
Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 10 the decision whether or not to continue with the planned activity. Residents said that this was a good way to make sure that they were not too protected. One resident said, “it helps when we get back into the real world.” Another said, “we have to look at every angle, our feelings as well as situations.” Health and safety risk assessments were carried out and monitored by staff. Holgate House DS0000009645.V280472.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): 12 and 16 Residents were supported to take part in activities appropriate to their treatment programme. Residents’ rights were upheld. EVIDENCE: Residents said that initially they did not really have time for anything except concentrating on the programme. One resident said, “we need to learn about structure and routine.” Another said, “we are learning a new way of life.” Time was set aside for leisure activities which were planned by the group. Towards the end of the programme staff assisted residents to look at what they wanted to do after discharge. One resident said staff talked to them about how to access further education. Another said they would like help to get employment. Staff said they also worked with outside agencies to find housing for residents when they were ready to move on. Residents talked about the home being “well balanced.” They said that there was a mixture of strict rules and routines but with enough freedom and choice. One resident said, “we have to be up at a certain time and go to bed at a certain time but we signed up for that.” Others said, “we take more responsibility for ourselves as the time goes on,” and “the group really runs Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 12 itself.” Residents said that staff were always very polite and respectful towards them. One said, “you genuinely feel they do care about you.” Holgate House DS0000009645.V280472.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): 20 Some shortfalls in the way medicines were managed may result in residents not receiving the correct dose of medication. EVIDENCE: None of the residents were self medicating. Each resident had a list of medication but these were not always kept up to date. There were complete records of medicines entering and leaving the home. Instructions on Medication Administration Record (MAR) charts did not always correspond with instructions on medicine labels. This had resulted in one resident receiving their antibiotics daily on some days and twice a day on others. Medicine for another resident was not always administered in accordance with instructions. Records showed that one resident who was prescribed “once daily” medicines did not receive it at the same time each day. The stock balance of medicines was recorded after each administration which provided a good audit tool. Medication storage was safe and there was restricted access to keys. Following a previous requirement, the records of controlled drugs had improved. Residents said they were satisfied with the way staff managed their medicines. One resident said, “staff always remind me that I have to take my tablets before I go to bed.” Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 14 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): 23 The lack of staff training in adult protection may result in abuse being unrecognised and unreported. EVIDENCE: The manager had revised the adult protection procedure following a recommendation at the last inspection. The procedure provided clear instructions for reporting any allegations of abuse outside the home. The previous requirement to provide training in adult protection had not been actioned. The manager stated that she had developed a training package and would be delivering this over the next few weeks. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 15 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 and 30 Residents were satisfied with the environment, which suited their needs and lifestyle. Some improvements would maximise their comfort. The lack of written guidance about minimising the spread of infection may place residents and staff at risk. EVIDENCE: Most areas of the home had been repainted since the last inspection and a new carpet had been laid in one of the bedrooms. A tour of the premises showed that there were still a number of areas in need of maintenance and refurbishment. Although the manager said there was a rolling programme to replace furnishings and redecorate, there was no written plan. Residents were happy with the environment. One said, “it’s a fantastic place to recover.” Another said, “it’s homely, you don’t feel as if you are in an institution.” Other comments included, “comfortable,” “relaxing,” and “peaceful.” The residents took responsibility for keeping the home clean and tidy. They were satisfied with this arrangement and there were risk assessments in place to support them. Despite a previous recommendation the infection control policy still did not include information about universal precautions and directions for cleaning spillages in order to minimise risk of cross infection.
Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 16 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): 34 and 35 Recruitment practices provided safeguards for residents. Staff had sufficient training to enable them to understand and meet the specialist needs of the residents. Lack of induction training records meant the competency of new staff could not be confirmed. EVIDENCE: Robust recruitment policies were in place. The file of a new employee showed that pre-employment checks were carried out. All the required documents and information were retained on file. Although the registered manager stated that the new employee had received induction training and initial supervision, there were no records to support this. The induction programme had not been reviewed in light of the changes to the induction standards of the national training organisation. NVQ training and other relevant courses, such as counselling, were available to new staff. Existing staff had the relevant qualifications to enable them to meet the needs of the residents. Residents said the staff were well trained. One said, “they are really good at what they do.” Staff were also described as, “very professional,” “accommodating,” and “knowledgeable.” Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 17 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): 37, 39 and 42 Residents and staff benefited from a well managed home. Residents were confident that their views would be listened to and acted upon. Lack of health and safety training may place residents and staff at risk. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 18 EVIDENCE: The registered manager had many years experience of working with the resident group. She held a management diploma and a diploma in person centred counselling, which was applicable to her work with the resident group. At the time of the inspection she was studying for a further diploma, which would enhance her work. Residents said the home was well managed. Several said that the manager and all the staff were very approachable. One resident said, “The manager oversees everything.” Residents were asked to completed satisfaction surveys at the point of discharge. All those seen were very positive. The manager said that surveys had been sent out to other professionals involved with the service. Although none of the questionnaires had been returned, the manager said they had received some very positive verbal responses. Residents said they had plenty of opportunities to make their views known and if they had any problems they would be addressed. Monthly resident meetings had been introduced and one resident said, “we talk about everything in the group meetings.” Another said, “if we raise things at meetings they get sorted out.” Action plans from the meetings confirmed this. Despite a previous requirement, only one member of staff had received fire safety training. Records showed that the monthly fire drills were successful with residents and staff following the correct procedure. The fire system had been serviced since the last inspection and alarms were tested regularly. All staff were trained in first aid but training in other safe working practices was not up to date. There were risk assessments to support the open storage and use of potentially hazardous cleaning materials and residents said that staff explained the risks to them on admission. Servicing of gas and electrical installations and appliances was up to date. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 19 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 X 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 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X 3 X X 2 X Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 20 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. 2. Standard YA20 YA20 Regulation 13(2) 13(2) Requirement Instructions on MAR charts must correspond with those on medicine labels. Medication must be given when prescribed or an explanation recorded as to why it has been omitted. Staff must receive training in adult protection issues. (Timescale of 30/11/05 not met) Areas of the home in need of repair, redecoration or refurbishment must be identified and an action plan drawn up with realistic timescales. A record of induction training must be kept on the staff file. All staff must receive fire safety training. (Timescale of 30/11/05 not met) All staff must receive update training in safe working practice topics. Timescale for action 03/03/06 03/03/06 3. 4. YA23 YA24 13(6) 23(2)(d) 30/04/06 31/03/06 5. 6. 7. YA34 YA42 YA42 19 & Schedule 4 23(4) 18 31/03/06 31/03/06 30/04/06 Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 21 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. 4. 5. Refer to Standard YA6 YA20 YA20 YA30 YA35 Good Practice Recommendations Supplementary care plans should provide clear directions for staff to follow. The list of medicines for each resident should be kept up to date. Medicines prescribed once daily should be administered at the same time each day. Infection control policies and procedures should be revised to include information on cleaning spillages and universal precautions. The induction training programme should meet the standards of the national training organisation. Holgate House DS0000009645.V280472.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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