Inspection on 02/08/06 for Holgate House

This inspection was carried out on 2nd August 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holgate House 17/07/07

Holgate House 01/03/06

Holgate House 14/09/05

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 Key Unannounced Inspection 2nd August 2006 09:30 Holgate House DS0000009645.V306969.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 Holgate House DS0000009645.V306969.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. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 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.V306969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 Brief Description of the Service: Holgate House is a small unit offering rehabilitation for service users 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 sized 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. Information about the home is given to prospective service users on referral. Copies of the latest inspection report are available from the manager on request. The registered manager confirmed that the fees at 2nd August 2006 ranged between £380.00 and £550.00 per week. The following items were not covered by the fee; hairdressing, toiletries, activities, magazines and papers. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place over 7 hours. At the time of the key inspection visit there were 7 service users accommodated. The inspector met with the service users in a group situation. This was in keeping with the ethos of the home, where group work was an essential part of the programme. Service users were asked about their views and experiences of living in the home and some of their comments are quoted in this report. Discussions were held with the registered manager and two members of staff. The inspector made a tour of the premises and viewed a number of records and documents. This report also includes information submitted by the registered manager prior to the inspection. None of the comment cards sent out to the home for service users and visitors were returned. What the service does well: Staff made sure that new service users were given enough information about the home to be able to make a choice as to whether it was the right place for them. They did not admit service users whose needs they were unable to meet. Staff encouraged service users to set their own goals and review their progress so that they knew exactly what to expect and what they were working towards. One service user said they wrote their own plans of, “what we want to achieve.” Staff were good at balancing the need to restrict activities with service users’ rights to privacy and freedom. Service users said staff encouraged them to look at the risks of relapse in everything they did. Service users said that staff wanted them to keep in touch with their families and helped them to find safe ways to do that. Service users felt safe in the home and could talk to staff if they had any problems. One said of the staff, “you feel that they genuinely want to help.” There was a low turnover of staff. The manager made sure that new staff had thorough background checks and were the right people for the job. The small staff team were qualified to provide counselling and work with groups. Service users said this was important as it “makes you feel they have a right to tell you things.” When asked what they thought the service did well, service users comments included, “I have had support from everyone here, staff and group” and “very well run, (the manager) runs a tight ship.” Holgate House DS0000009645.V306969.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. Holgate House DS0000009645.V306969.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 Holgate House DS0000009645.V306969.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 at least once during a 12 month period. 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. The admission process was thorough and ensured that the service user’s needs were understood. EVIDENCE: Service users said they were sent lots of information about the home, “what the place is about and what is available”. The house rules and expectations were included in the document so that service users were aware of what was expected of them. The manager had access to full health and social care assessments before inviting a prospective service user for an introductory visit. A brief assessment was conducted at this point to ensure the programme was suited to the needs of the service user and that they were compatible with the existing group. Service users said the assessment visit was “very helpful” and that staff had been “friendly and welcoming.” Holgate House DS0000009645.V306969.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 at least once during a 12 month period. 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. Service users were involved in setting their own goals, and care plans provided staff with sufficient information about treatment approaches. Staff provided support and guidance to enable service users to take risks and make decisions about their lives. EVIDENCE: All service users had a 12 step plan for abstinence. Service users said they also filled in their own plans with “what you want to achieve.” All wrote their own diaries, life histories and short-term objectives, which one service user said was, “more useful than the plan.” Progress was reviewed every week and objectives were re-adjusted. Staff said they tried to encourage service users to make decisions about everything not covered by the 12 step programme. Service users said they made decisions about meals, group activities and, up to a point, how to spend their leisure time. Most decisions were made within the group. One said, “even if you make a decision that only affects you, you still bring it up with the group.” All activities were risk assessed. Service users said this included visits in or out of the home, activities or walks to the village. They said they looked at Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 10 every aspect of the activity and how it might affect them and their risk of relapse. The decision as to whether the activity should go ahead was down to the group or in some cases to be discussed with an individual’s counsellor. Holgate House DS0000009645.V306969.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users agreed with the restricted lifestyle they had whilst taking part in the rehabilitation programme. EVIDENCE: The treatment programme was very full and did not allow for many other activities. As service users were getting ready to move on staff assisted them to look at new areas of activity and occupation to fit in with their new lifestyle. Staff also helped with housing, budgeting and other areas of daily living. House rules and restrictions were made clear in the statement of purpose. For example, service users were not allowed to go out without permission. Service users accepted these rules, and one said, “there’s a good balance between rights and restrictions” Restricted visiting was agreed at the beginning. Home visits were a gradual progression depending on the service user’s risk assessment. Service users were satisfied with the arrangements and said, “They want you to keep in touch with your family and children.” Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 12 There was minimal community contact during the early stage. Community links were mostly though AA and NA meetings. Community activities increased as service users were ready for discharge, but still within a risk assessment framework. There were some leisure activities built into the programme. Staff described the weekly group activity as a wind down session. Service users were responsible for planning, shopping and cooking on a rota basis. All were in agreement with this and one said, “it gives us some responsibility.” Staff checked the menus to ensure there was a variety and a degree of healthy eating. Holgate House DS0000009645.V306969.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 at least once during a 12 month period. 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. Service users’ ongoing healthcare needs were not understood or met. Shortfalls in medication records may result in service users not receiving the correct medication. EVIDENCE: There were strict times for personal care routines within the treatment programme. There was an expectation that service users would be appropriately dressed and groomed on all occasions. Staff support was available if necessary. Service users’ additional physical and mental health needs were not being met. Staff were not aware that one service user had a long history of mental illness or what their daily living needs were as a result of this. There were no mental health assessments or evidence of monitoring. Healthcare plans did not provide staff with directions for care except to arrange appointments and administer medication. Despite these shortfalls, a service user said that staff had looked after her very well during a recent illness and had called out the emergency doctor. All staff had received training in handling medication. There was a risk assessment in place for a service user who administered some of their own Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 14 medicines. Each service user 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 and the stock balance of each item was recorded after administration. The records of leave medication were not consistent and were confusing. All medication administration record (MAR) charts were handwritten. They were signed, and instructions corresponded with the directions on packaging. However, there were gaps on MAR charts that were not explained. General storage areas were secure and there was appropriate storage for controlled drugs. Medication belonging to service users no longer in the home were still in the cupboard. Holgate House DS0000009645.V306969.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 at least once during a 12 month period. 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. Service users were protected by the policies and practices of the home. EVIDENCE: Service users were given a copy of the complaints procedure, which stated how complaints would be dealt with and within what timescale. Neither the home nor the Commission had received any complaints. Service users named staff they would speak to if they had any concerns. They were confident they would be dealt with. The protection of vulnerable adults policy was complete and the local authority procedure was available for reference. All staff had received training in the protection of vulnerable adults. Staff and management were aware of their responsibilities in reporting any allegations. Service users said they felt safe at the home. They were aware that there were systems in place to protect them from abuse or bullying from other service users. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was suitable for needs and lifestyle of the service users. EVIDENCE: Service users were satisfied with the layout and facilities in the home. Their comments included, “very nice house,” and “very comfortable.” There was a plan for maintenance and renewal and records showed that timescales were being met. Service users confirmed that repairs were carried out and one said, “if there’s something needs doing, they do it.” A number of service users had new beds after commenting to the manager that the old beds were uncomfortable. There were some comments about the comfort of the chairs, which were due to be replaced, and the lack of ventilation in bedrooms, which the manager said she would pursue. On the day of the visit the home was clean and tidy. Service users were responsible for domestic tasks and their own laundry. All said they were happy Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 17 with this arrangement. Staff had received infection control training. The policy had been reviewed to include cleaning of spillages and universal hygiene precautions. Notices were displayed for service users to help them minimise any risk of picking up and spreading infection. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 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): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by the home’s recruitment practices. The staff team were qualified to meet the specialist needs of the service users. EVIDENCE: Robust recruitment policies were in place. The file of a new employee showed that pre-employment checks were carried out and the required documents and information were retained on file. Records did not provide a clear indication of the content of the induction training for the new employee. Not all sections of the training were signed or dated. The programme did not meet the common induction standards set by the national training organisation or the drug and alcohol national occupational standards (DANOS). Staff had the relevant qualifications to enable them to meet the needs of the service users and they kept their professional qualifications up to date. Service users said that they thought the staff were qualified and competent. One said they had asked and been shown a member of staff’s certificates. Another said that knowing the staff were qualified gave him, “confidence that they know what they are talking about.” Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an effective manager in place who ensured that the home was run safely and in the best interests of service users. EVIDENCE: The registered manager had many years experience of working with the service user group. She held a management diploma and a diploma in person centred counselling, which was applicable to her work. At the time of the inspection she was studying for a further diploma, which would enhance her work. Service users said the home was well managed. One said that the manager “runs a tight ship.” Service users were asked to complete satisfaction surveys during their admission and on discharge. All those seen were very positive. The manager had followed up any comments or suggestions by talking to the service user directly where possible. She had made a list of issues to be monitored or Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 20 improved but there was no action plan or timescales. The manager had redistributed questionnaires to other interested parties, such as referral teams, but had still not received any responses. There were no audits of systems or procedures such as care plans or medication. Staff had received update training in health and safety topics, including fire safety. Drills, involving staff and service users, were held every two months and records of outcomes were kept. The fire risk assessment was reviewed every month. Fire safety equipment was serviced regularly. Records showed that electrical equipment and installations were tested and serviced. Risk assessments were in place where service users had access to potentially hazardous items. All staff were qualified first aiders. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 21 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 3 33 X 34 3 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 3 X 2 X X 3 X Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 22 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. 3. Standard YA19 YA19 YA20 Regulation 14 15 13(2) Requirement Information about service users’ health care needs must be communicated to staff. The service user’s plan must address physical and mental health care needs. Medication belonging to service users no longer accommodated in the home must be returned to pharmacy. Medication must be given when prescribed or an explanation recorded as to why it has been omitted. (Timescale of 03/03/06 not met) A complete record of induction training must be kept on the staff file. (Timescale of 31/03/06 not met) Timescale for action 31/08/06 31/08/06 31/08/06 4. YA20 13(2) 31/08/06 5. YA35 19 & Schedule 4 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1. YA20 The procedure for recording leave medication should be followed by all staff. 2. YA20 The list of medicines for each service user should be kept up to date. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 23 3. 4. 5. YA24 YA35 YA39 The registered person should continue with the plans for improving the environment. The induction training programme should meet either the common induction standards or the drug and alcohol national occupational standards for induction. The quality monitoring system should be further developed. Holgate House DS0000009645.V306969.R01.S.doc Version 5.2 Page 24 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 © 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 DS0000009645.V306969.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!