CARE HOMES FOR OLDER PEOPLE
Hollin Bank House Blackburn Road Oswaldtwistle Lancashire BB5 4PE Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 4th September 2007 11:00 X10015.doc Version 1.40 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 Hollin Bank House DS0000009433.V344949.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 Older People. 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. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hollin Bank House Address Blackburn Road Oswaldtwistle Lancashire BB5 4PE 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) 01254 236841 01254 236841 ray.pullinger@yahoo.co.uk Mr Raymond John Pullinger Mrs Sylvia Pullinger vacant post Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (11) Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. In annexe 2 the number of service users in each category is 11 OP, 1 MD(E) 1 MD and 1 DE(E) 21st August 2006 Date of last inspection Brief Description of the Service: Hollin Bank House offers 24-hour personal care for up to 14 people. The service has been registered as a care home, providing care for over 20 years, by the same registered owners. The home is a detached property set in a residential area approximately one quarter of a mile from Oswaldtwistle town centre. The home is close to a main road that is serviced by public transport. Accommodation is provided in single or twin-bedded rooms. A stair lift facilitates access to all areas of the home. Communal lounges and dining room are located on the ground floor. The current fees charged at Hollin Bank House are £362 to £425 per week. Additional charges are payable for hairdressing dry-cleaning and personal items. A copy of the statement of purpose and service user guide is available on request. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Hollin Bank House on the 4th September 2007. One additional visit has been made since the last inspection. Eight completed surveys were received from residents, six from the relatives of residents and two from GP’s. At the time of this inspection 12 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty and residents were spoken to. Discussions also took place with the manager and assistant manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Prospective residents are visited and assessed prior to admission. Prospective residents or their relatives receive confirmation in writing that their needs can be met at the home. Recruitment procedures were thorough. A criminal records bureau check and two written references were obtained before a new member of staff started working at the home. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 6 A notice was displayed in the dining room inviting visitors to sign the book and state their time of arrival and departure. Fire drills were held regularly and a staff attendance record was kept to ensure all members of staff received this training. Wheelchairs with footplates were in use at the time of the inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: The care records of a resident admitted to the home within the last few months were inspected. These records contained a detailed pre-admission assessment. The manager or a member of the management team visited and assessed prospective residents in hospital or their own home prior to admission. These assessments provided important information for the care plans. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning and medication procedures means residents do not always receive person centred care. EVIDENCE: The individual care plans of two residents were inspected. These plans did not identify and address all the care needs of each resident. Not all care records were signed or dated. Some care plans did not provide clear guidance for staff to follow to ensure the needs of the resident were met. The care plan about moving and handling for one resident stated ‘ensure staff are aware of correct methods of transfer’ but did not provide information about the equipment to use or the number of staff required. A risk assessment stated one resident had a high risk of developing pressure sores but a care plan to address this problem was not in place.
Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 10 The care plan for one resident indicated there had been some weight loss. However, there was no evidence to suggest she had been weighed between May and September this year. Not all care plans and risk assessments were reviewed monthly. Several risk assessments had not been reviewed since April and one relating to pressure sores had not been reviewed since October last year. There was evidence to suggest that residents or their relatives were involved in care planning. However, it was of concern that the deputy manager and a relative of one resident had signed a blank review sheet in the care records for June, July and August. There was no evidence to suggest a review of the care plan had taken place. A written report about the care given to individual residents was completed during each shift. Residents were registered with a GP and had access to other healthcare professionals. Records for the management of medication were in place. Members of staff responsible for the administration of medication had received training. Medication was stored in a locked cupboard in the kitchen. The temperature of this area was checked daily. Poor practice was observed at teatime on the day of the inspection when medication was left on the dining table for a resident. This practice increases the risk of error and puts residents at risk if they mistakenly take this medication. Personal care was carried out in private. Members of staff were observed attending to residents in a friendly and professional manner. One resident said, “They’re very nice to me.” Another resident said, “The staff look after me.” Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected and they were supported by care workers to lead a fulfilling lifestyle. EVIDENCE: Residents were encouraged to pursue their own interests and hobbies. One resident was doing puzzles at the time of the inspection. One lady said she enjoyed knitting and another lady said she liked reading. One resident said they played dominoes and sometimes whist. Outside entertainers regularly visited the home. One relative commented on their survey that birthdays and Christmas were always celebrated with a party. Visitors were welcomed into the home at any reasonable time and offered refreshments. One visitor said she was always made welcome. Local clergy regularly visited the home for communion and also when requested by individual residents. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 12 Residents were encouraged to make decisions about their lifestyle and daily routine. Residents had personalised their rooms with photographs, ornaments etc. The meal served at lunchtime on the day of the inspection was wholesome and appetising. Although a choice of meal was not offered alternatives were readily available. The mealtime was unhurried allowing residents time to chat and enjoy their meal. All the residents asked said the meals were good. One resident said, “I enjoy all my meals.” Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents felt able to express their concerns. Staff had the training necessary to ensure the safeguarding of vulnerable adults EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the service user guide. One resident said she had no complaints but would tell the manager or another senior member of staff if she had. Policies and procedures relating to the protection of vulnerable adults were in place. All members of staff had received training in safeguarding vulnerable adults. This issue was discussed with two members of staff. They were aware of the procedure and said they would report any concerns immediately. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were well maintained and provided a comfortable and ‘homely’ environment for the residents. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. This provided a safe and comfortable environment for the residents. All the residents who completed the survey stated the home was always clean. The grounds and gardens were well kept and accessible to all residents. One resident she liked to sit outside when the weather was nice. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 15 Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Members of staff had the skills and knowledge necessary in order to meet the needs of the residents. Recruitment procedures were thorough. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to ensure the needs of the residents were met. A member of the management team was always on call in case of emergency. The files of three members of staff appointed since the last inspection were examined. These files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from discussions with the manager and members of staff that training was actively encouraged. This included induction training for new members of staff, first aid, basic food hygiene, fire safety, medication awareness, moving and handling, dementia care and infection control. The deputy manager has completed NVQ level 3, the NVQ registered manager’s award and is working towards NVQ level 4 in care. The assistant manager has completed NVQ level 3 and 4 in care and is working towards the
Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 17 NVQ registered manager’s award. Six care workers have an NVQ level 2 and three have NVQ level 3. In addition to this a further three members of staff are working towards NVQ level 2 and four towards level 3. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed. The views of residents are considered when decisions about the care and facilities provided at the home are made. EVIDENCE: The manager is a registered nurse with many years experience of managing a care home. He maintains an up to date knowledge of current practice by attending relevant seminars and reading articles in a variety of care publications. Members of staff said the manager was helpful and supportive. The home has achieved the nationally accredited Investors in People award. Residents were encouraged to give feedback about the care and services provided at anytime. However, anonymous satisfaction questionnaires had not been given out to residents for over a year. The manager explained residents
Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 19 and relatives meetings took place every two to three months. Minutes of the meeting held on 24 April 2007 were available. Staff and management team meetings took place regularly. Minutes of these meetings were also available. An annual business plan to help monitor the quality of the service and further improve outcomes for residents was in place. Records of transactions involving resident’s money were seen to up to date. A notice was displayed in the dining room asking all visitors to sign the book on arrival and departure. Records were stored securely and available only to authorised personal. However, the accident book included information about more than one resident on each page. This information is therefore not confidential to each individual resident and clearly in breach of the data protection act. Policies and procedures for safe working practices were available. Fire alarms and emergency lighting were tested weekly. Fire drills took place regularly and a staff attendance record was kept to ensure all members of staff received this training. An up to date fire risk assessment was in place. Records of the routine servicing of equipment were seen. These included an electrical installation certificate and evidence that the testing of small electrical appliances had taken place in January 2007. However, a gas safety certificate was not available. During the inspection members of staff were observed using the incorrect and dangerous underarm lift to transfer a resident into her wheelchair. Although the manager said the resident preferred this method it does put both the resident and members of staff at risk of serious injury and must not be used. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1) Requirement Timescale for action 02/11/07 2 OP7 15(2)(b) 3 OP8 12(1)(a) (b) 4 OP9 13(2) To ensure the care needs of all residents are met. Care plans must accurately identify and address the care needs of each resident. This includes moving and handling and prevention of pressure sores. Timescale of 28/04/06 and 29/09/06 not met. To ensure staff have the 02/11/07 information necessary in order to meet the needs of all residents care plans and risk assessments must be reviewed monthly. Residents or their relatives must be involved in these reviews. Relatives must not be asked to sign blank review sheets. Timescale of 29/09/06 not met. 28/09/07 To prevent residents from becoming malnourished action must be taken to ensure residents who are losing or have a history of weight loss are closely monitored. This includes checking their weight regularly at least once a month. To prevent medication error staff 28/09/07 must ensure that all medication
DS0000009433.V344949.R01.S.doc Version 5.2 Hollin Bank House Page 22 5. OP38 13(5) is given to the resident and not left on the dining table. Timescale of 21/08/06 not met. To prevent injury to residents and staff approved, safe moving and handling procedures must always be used. Timescale of 21/08/06 not met. 28/09/07 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. Refer to Standard OP7 OP37 Good Practice Recommendations All care plans should be signed and dated. Accident reports should be recorded on a separate sheet for each resident and stored in the individuals care plan. Hollin Bank House DS0000009433.V344949.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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