Inspection on 14/09/05 for Holgate House

This inspection was carried out on 14th September 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Holgate House 17/07/07

Holgate House 02/08/06

Holgate House 01/03/06

Holgate House 01/02/05

Holgate House 20/07/04

Holgate House 25/02/04

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Hamer Cottage

Turning Point (Hoole Road)

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

CARE HOME ADULTS 18-65 Holgate House Mill Bridge Mill Lane Gisburn Lancashire. BB7 4LP Lead Inspector Jane Craig Unannounced 14 September 2005 13:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Holgate House Address Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP 01200 445200 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Holgate House Limited Miss Zoe Louise Ingham Care Home Only Personal Care (PC) 7 Category(ies) of Past or present alcohol dependence (A) 7 registration, with number of places Past or present drug dependence (D) 7 Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01 February 2005 Brief Description of the Service: Holgate House is a small unit offering rehabilitation for persons with a history of drug and/or alcohol dependency. 24-hour personal care and accommodation can be offered to seven adults. The treatment approach at Holgate House is person centred and cognitive therapy based on the 12-step 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 F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day. At the time there were 6 residents accommodated for short stay rehabilitation. The inspector met with all 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: What has improved since the last inspection? There had been some improvements in the medication policies and risk assessments for residents wishing to administer their own medication. Staff had received training in infection control. A member of staff had been appointed as fire warden after attending a fire safety training course. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 6 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 F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 1, 2 and 5 Prospective residents received sufficient information to enable them to make a decision about whether to enter the home. The admission process was thorough and ensured that the prospective resident’s needs were understood and both residents and staff were aware of their responsibilities. EVIDENCE: There was a combined statement of purpose and service user’s guide. The document provided comprehensive information about the aims and objectives of the home, the environment and the programme. Prospective residents were also sent information about the house rules and restrictions. Staff had access to assessments and reports compiled by health and social care professionals. Residents said they were assessed by social workers first and then invited to Holgate House for a half-day visit. A brief assessment was conducted to ensure the programme was suited to the residents needs. Their compatibility with the rest of the group and commitment to the programme was assessed. Residents said that staff were very welcoming and understood their needs completely. All residents signed a contract on admission to the home. The contract specified restrictions on choice, freedom and services as a result of the programme. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 6 and 7 Residents were involved in setting their own goals and care plans provided staff with sufficient information about treatment approaches. There was insufficient information about other care needs to ensure that they were understood or met. Staff provided support and guidance to enable residents to make decisions about their lives. EVIDENCE: On admission residents were asked to complete a full assessment and identify their treatment goals. Care plans were agreed between the resident and their counsellor. Care plans followed the 12 step programme and identified treatment approaches to be used. However, areas of need not addressed within the programme did not have separate care plans identifying how these needs were to be met. Residents said they reviewed their objectives each week with input from their counsellor and the rest of the group. Residents said they were encouraged to discuss and explore anything of any importance with the group or with staff but they ultimately made their own decisions. One said “we have a lot of involvement and just get a bit of guidance.” Another said, “this house is ours, we run it together.” They spoke about the need for restrictions and limitations at the beginning and said that it Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 10 was more flexible towards the end of the programme. One resident said “we get a lot of trust and it makes you return it.” Residents talked about getting peer support from the group. Staff also took them to local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups. Residents were usually able to manage their own finances. Records were in place where there was involvement by staff. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 13, 15 and 17 Residents were supported to access and use community facilities in accordance with their agreed programme. Residents were supported to maintain appropriate relationships and cease those that may be harmful. Residents received a balanced diet with meals of their choice. EVIDENCE: Residents talked about going to the local village in small groups if their risk assessments allowed. There was a weekly group activity led by staff. Residents chose where they wanted to go, for example, to the cinema, swimming, local walks and bowling. Residents said they had very little involvement in the local community until near the end of their programme. Before the second phase of the programme residents were supported to access appropriate community services and facilities. There was limited visiting which was made clear in the house rules. There were restrictions on the visitors residents were allowed to see or contact by telephone. Some friendships were actively discouraged. Residents said staff discussed the rules with them and they understood the reasons for the Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 12 limitations. Staff said there was some flexibility especially when residents’ children were involved. Family therapy was offered at the home. Residents said they took turns to plan, shop and cook the meals for the rest of the group. They were happy with this arrangement, which was seen as part of their social routine. Staff checked the planned menus to make sure they were appropriate. Residents said the staff made sure they had a balanced, healthy diet. During the course of the inspection staff were seen to supervise hygiene practices of residents in the kitchen. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 18, 19 and 20 Residents said their healthcare needs were met but failure to develop care plans may result in a lack of intervention in the future. Inaccurate or unclear records of medicines may result in drug errors and harm to residents. EVIDENCE: None of the residents required assistance with personal care routines. Times for getting up, going to bed and social time were strictly planned within the programme. All residents were registered temporarily with a GP on their admission to the home. Ongoing healthcare needs were monitored and residents said it was good that staff initially took over the responsibility for making sure they attended health care appointments. Existing health care needs were mentioned on care plans but should be more obvious to ensure that staff had clear directions as to what assistance may be needed (see standard 6). Residents said that staff were very good at looking after their healthcare needs. One said “they don’t question if you’re not well, they just get help.” A requirement and two recommendations to improve medication practices remained outstanding from the last inspection. Other recommendations had been actioned. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 22 and 23 Residents knew they could raise concerns or complaints and they would be acted upon. The lack of policy guidance and training in adult protection may result in any allegations of abuse not being appropriately reported or investigated. EVIDENCE: A copy of the complaints procedure was included in the resident’s care plan. Residents said that they were encouraged to talk about any concerns either in groups or with their counsellor. One resident said “nothing is too small to discuss” and another said, “staff will work it out with you, they take it sincerely.” The Commission had not received any complaints about the service. The protection of vulnerable adults policy was not complete. The local authority procedure was available for reference. A member of staff spoken with had not received training in adult protection issues. They did not have a clear understanding of the procedure for reporting abuse or the whistle blowing policy. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 standard(s) 24 and 30 The home was clean and tidy but the standard of decoration must be improved in order to maximise residents’ comfort. The lack of written guidance about minimising the spread of infection may place residents and staff at risk. EVIDENCE: Some areas of the home were shabby and in need of redecoration. Communal rooms, bathrooms and some bedrooms needed repainting. The carpet in one bedroom was torn and taped with carpet tape. Residents said their bedrooms were ok, that they had enough space, furniture and furnishings. Residents were responsible for their own cleaning and laundry. All areas of the home were clean and tidy at the time of the inspection. The registered person had obtained a kit for cleaning potentially infectious spillages but there was no written guidance for staff on how to deal with spillages. Staff had received awareness training in hygiene and infection control. Protective clothing was available. The infection control policy/procedures had not been reviewed to provide staff with guidance on universal precautions. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 Residents were supported by a knowledgeable and skilled staff team. EVIDENCE: Residents were very complimentary about the staff. They said they were supportive, knowledgeable and skilled. They were appreciative of the accessibility of staff. One resident said he was surprised when, on admission, he was told that staff were available to talk to at any time day or night. Other residents confirmed that they had been able to approach staff at any time. Residents felt they were respected, well cared for and that staff clearly understood their needs. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 Residents’ views were sought and suggestions were acted upon, however a lack audit and forward planning may restrict development of the service. Not all health and safety measures were in place which may result in residents and staff being placed at risk. EVIDENCE: Residents said they were regularly asked their opinions about the service and were encouraged to make suggestions. They said that suggestions were discussed and if they could not be acted upon, they were given valid reasons why not. On discharge residents were asked to complete a brief questionnaire. All those seen were very positive. The registered manager had sent out surveys to referring agents and other stakeholders but had not received any response. There were no systems for auditing the service and the annual development plan, required following the previous inspection, had not been produced. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 18 The registered person confirmed that staff training in safe working practice topics was up to date but records were not seen at the time of the inspection. Residents had access to potentially harmful substances. There were no risk assessments to support this practice. Testing of gas and electrical installations was up to date. Portable appliances were tested in June 2005 but not all items had test stickers, there was no schedule available. Fire safety training was out of date. A fire warden had been appointed and training was planned. A fire risk assessment had been drawn up and practice drills were carried out. Records of drills did not specify who was involved or the outcomes. Extinguishers, alarms, and other equipment were tested. The registered person must check that the fire system maintenance certificate is still valid. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 4 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 4 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x x 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 4 x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holgate House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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. Standard 6 Regulation 15 Requirement The care plan must include clear directions for staff as to how residents needs are to be met. This must include needs not addressed by the 12 step programme. An accurate record must be kept of any Controlled Drugs (including Subutex and Methylphenidate preparations) received, administered or disposed of. Staff must receive training in adult protection issues. The adult protection procedure must include information on reporting an alleged incident. All areas of the home must be reasonably decorated. The registered person must develop systems for auditing the service. An annual development plan must be produced. All staff must receive fire safety training. The registered person must risk assess the present storage arrangements for potentially hazardous substances. The risk assessment must be reviewed as new residents are admitted. Timescale for action 31/10/05 2. 20 13(2) 30/09/05 3. 23 13(6) 30/11/05 4. 5. 24 39 23(2)(d) 24(1)(3) 31/03/06 31/03/06 6. 7. 42 42 23(4) 13(4) 31/11/05 30/09/05 Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 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. Refer to Standard 20 30 42 42 Good Practice Recommendations A second member of staff should witness all hand written entries on Medication Administration Record charts. Infection control policies and procedures should be revised to include information on cleaning spillages and universal precautions. The registered person should check the validity of the fire system maintenance certificate and verify that all portable appliances have been tested. Records of fire drills should include names of those involved and information about outcomes. Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB 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 Holgate House F57 F07 S9645 Holgate House V240542 300805 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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