Inspection on 05/06/07 for Hollin Knowle

This inspection was carried out on 5th June 2007.

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

Hollin Knowle 29/04/08

Hollin Knowle 06/11/07

Hollin Knowle 30/05/06

Hollin Knowle 16/06/05

Hollin Knowle 23/03/05

Hollin Knowle 05/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Hollin Knowle 78 Fairfield Road Buxton Derbyshire SK17 7DR Lead Inspector Rose Veale Unannounced Inspection 09:30 5th June 2007 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 Knowle DS0000020019.V337164.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 Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hollin Knowle Address 78 Fairfield Road Buxton Derbyshire SK17 7DR 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) (01298) 22534 Mr Mohammed Shamsul Islam Mrs Shajeda Islam Mrs Shajeda Islam Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: Hollin Knowle is a care home registered to provide personal care and accommodation for up to 19 residents aged 65 years or over. The home is situated on the outskirts of Buxton where a variety of amenities are available. Local shops are near to the home. Accommodation is provided over 3 floors which are accessed via a passenger lift. There are 2 lounge areas and a dining room. Additional communal space consists of a sitting area on the first floor adjacent to bedrooms. Gardens and car parking space are also provided. Information about the home, including CSCI inspection reports, is available at the home or from the owner/manager. Fees at the home range from £333.85 to £352.00 per week. This information was provided on the pre-inspection questionnaire completed by the owner / manager and received on 14.05.07. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 6 hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 15 residents accommodated in the home on the day of the inspection visit. 5 residents and 3 staff were spoken with during the visit. The owner/manager was available for most of the inspection visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of most areas of the building was carried out. A questionnaire and surveys had been completed and returned prior to the inspection and information from this has been included in the body of this report. There was a random, unannounced inspection visit in September 2006. The purpose of the random inspection was to assess compliance to the requirements made at the inspection of 30.05.06. Reference to the findings of the random inspection is included in the body of this report. What the service does well: What has improved since the last inspection? Some areas of the home had been redecorated. The laundry and food storage room floor had been coated to provide a washable, non-slip surface. The manager had completed NVQ Level 4. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Hollin Knowle DS0000020019.V337164.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 Knowle DS0000020019.V337164.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a thorough needs assessment process so that residents were confident the home was able to meet their needs. EVIDENCE: The care records of 3 residents were examined. All the records had a range of assessment information obtained before and on admission to the home. The information obtained prior to admission included assessments by Social Services and hospital staff. There were copies of letters confirming that the home was able to meet the needs of residents. The survey responses received indicated that residents felt they usually had the care and support they needed. Residents spoken with confirmed that they felt their needs were met at the home. Standard 6 did not apply to this service. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 9 Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 10 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. There was an inconsistent approach to care planning and review so that it was not clear that residents’ needs were always fully met. EVIDENCE: Of the 3 residents’ records examined, 2 had care plans produced from the assessment information. The 2 care plans covered the assessed needs of the residents and had detailed information about the residents’ personal preferences regarding daily routines. 1 of the care plans had been reviewed 3 months after the admission of the resident, the other had not been reviewed. 1 of the care plans had outdated information about the support needed with mobility by the resident. There was no evidence that residents / their representatives were involved in planning care. 1 record seen had no care plan, although there were detailed assessments and risk assessments. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 11 Staff spoken with were knowledgeable about the care needs and preferences of residents. The responses to the surveys indicated that residents felt their needs for care and support, including medical support, were usually met. There were records of the input of other healthcare professionals, such as GP, District Nurse, chiropodist and optician. There was evidence that residents were promptly and appropriately referred for healthcare treatment. Residents spoken with confirmed that they were able to see their GP when they needed to. Medication at the home was securely stored and was administered by the senior care assistants. Most of the senior care assistants had received appropriate training in safe-handling and administration of medication. The Medication Administration Records (MARs) seen were generally correctly completed. Where there were handwritten entries of details of medication, these were not signed by the staff member who had written them, or countersigned by another member of staff to show the entry had been checked as correct. Medication received into the home was not always recorded. There were good records of medication returned to the pharmacist. It was observed that there appeared to be good relationships between residents and staff with spontaneous affection shown. Staff were observed to be respectful in their approach to residents. Residents spoken with said that staff were “kind”, “helpful” and “patient”. There was 1 comment that although staff listen and respond to what residents say, information is not always passed on to other staff. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 12 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. There was a reasonable range of activities provided and the meals were of a good standard so that the lifestyle in the home generally met the expectations and preferences of residents. EVIDENCE: The care records seen included details of the residents’ family, work life, previous interests and spiritual needs. There was a range of activities provided at the home, including a visiting organist, a weekly music and movement session, and a regular church service held at the home. 2 residents said they enjoyed sitting out in the front garden, another resident said they enjoyed reading the newspaper each day. 1 resident said they would like to go out more. The responses to the surveys indicated that there were not always enough activities provided. It was commented that there was “not enough stimulation” for residents. One member of staff had recently taken responsibility for organising activities and was looking into arranging a trip out. Staff spoken with said they usually Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 13 had time to organise activities for residents in the afternoons, such as dominoes or music. Residents spoken with said they could get up and go to bed when they wanted to within reason. Residents were encouraged to bring in their own possessions and the bedrooms seen were well personalised. Residents spoken with said that the meals provided were of a good standard. The responses to the surveys indicated that most residents were satisfied with the meals. The cook spoken with was experienced, qualified, and knowledgeable about the needs and preferences of residents. The menus seen appeared varied and balanced. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. The complaints system was not sufficiently robust to ensure that all residents’ complaints were taken seriously. Residents were put at risk by poor recruitment practices. EVIDENCE: There had been no complaints received by CSCI about the home since the last inspection. The manager said the home had not received any formal complaints. Less formal concerns raised by residents / their representatives were not recorded in the complaints records. They were usually noted in the staff communication book but the action taken and the outcome was not always recorded, and there was no clear audit trail of how these concerns were dealt with. The survey responses indicated that residents were aware of the complaints procedure and were able to talk to staff or the manager about any concerns. 3 residents spoken with said they would talk to the manager if they had any complaints or concerns. Staff at the home had not completed training in safeguarding vulnerable adults. Staff spoken with were aware of adult protection issues and procedures. The home had satisfactory policies and procedures in place regarding safeguarding adults and whistle-blowing. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 15 Staff records examined did not include all the required documents and information. There were 4 staff working at the home without Criminal Records Bureau (CRB) disclosures in place. (See Staffing section of this report). Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally adequately maintained, clean and comfortable so that residents were provided with a safe and pleasant environment. EVIDENCE: Most parts of the building were seen, including many of the bedrooms. Several areas of the home had been redecorated since the last inspection, including the corridors and several bedrooms. An impermeable coating had been applied to the floor in the laundry and food storage areas as required at the last inspection. The manager said that it was planned to refurbish and redecorate the lounge / dining room. On the day of the inspection visit, the home was clean throughout and free from offensive odours. The survey responses indicated that the home was usually clean and fresh. Residents spoken with were pleased with their bedrooms and said the home was usually clean. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 17 Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and staff training were sufficient to meet residents’ basic needs. Poor recruitment practices put residents at risk. EVIDENCE: The rotas were seen and showed that there were usually 2 care assistants on duty during the morning and afternoon shifts, and 1 waking care assistant plus 1 sleeping in during the night shift. The manager usually worked at the home on 4 days per week and was supernumerary. There was also a cook, cleaning staff and a maintenance man. The survey responses and residents spoken to said that staff were usually available when needed. Staff spoken with said that staffing levels were appropriate to the needs of the residents. At the inspection in September 2006, staff spoken with said that the manager would provide extra staff when needed to take residents out, or if a resident needed additional care. As there were residents who needed 2 staff to assist them, there were times when both care assistants were busy and the lounges were left unsupervised. The records of 4 members of staff were seen. It was found that none of these staff had a Criminal Records Bureau (CRB) disclosure. The CRB disclosure had been applied for in one case but the POVA First check had not been requested and the staff member did not have all the other required information and Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 19 documents in place. The other 3 staff did not have full employment histories or 2 written references as required. An Immediate Requirement was made to ensure arrangements were made to protect residents. The manager took action to comply with the Immediate Requirement within the given timescale. However, the information provided was not sufficient to comply with the Immediate Requirement and further clarification was obtained from the manager. It had been found at a previous inspection that staff records did not include all the required information and documents. Of 14 care staff, 8 had already achieved National Vocational Qualification (NVQ) at level 2 or above, and another 3 were working towards NVQ. The staff training records seen showed that most of the senior care assistants had completed training in safe-handling of medication. Most staff had received training in manual handling, fire safety and first aid. Although there were individual training records, there was no overall training plan for the home. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were gaps in records, the quality assurance system was not fully developed, and there were poor recruitment practices so that the safety, welfare and best interests of residents were not effectively promoted. EVIDENCE: The manager was experienced, having owned and managed the home for many years, and said she had recently completed NVQ Level 4. Residents and staff spoken with said the manager was approachable. The manager said that quality assurance surveys were sent out each year to residents / their representatives. Completed surveys were seen for 2006. The manager said she would discuss individually with residents / their representatives any concerns raised, although there was no evidence of this. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 21 There was no report produced of the analysis of the surveys and action taken to address issues raised. The records were seen of residents’ personal money held by the home. The manager and senior care assistants had access to the money. The records seen had details of each transaction, usually with 2 signatures. Health and safety records were checked. The fire log book showed that weekly checks had been carried out up to date. At the inspection visit in September 2006 it was found that there were no records of fire drills, and staff spoken with could not recall when the last fire drill had taken place. Following the September inspection visit, a letter of serious concern was sent to the provider requesting urgent action to be taken to address this issue. The owner / manager provided satisfactory evidence that appropriate action had been taken. Evidence was seen of regular servicing and maintenance of the passenger lift. The manager said that 2 lifting hoists at the home were not in use and had not been serviced. 1 resident had been provided with a lifting hoist that was serviced and maintained by the local Primary Care Trust. The electrical safety certificate for the home had expired by nearly a year. Accident records were satisfactory and the manager had started a monthly audit of accidents in the home. It was observed that a resident was transported in a wheelchair with no footplates. This was discussed with the manager who said that this was necessary because of the particular disabilities of the resident. There was no detail of this in the resident’s care plan and no risk assessment in place. There were poor recruitment practices with documents and information missing from staff files. (See Staffing section of this report). No notifications of deaths and other incidents at the home had been received by CSCI. The manager said that notifications had been sent of deaths at the home, but there were no copies available for inspection. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 22 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 3 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 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 23 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 Care plans must include all the assessed needs of residents and must be produced in consultation with residents or their representatives. This will ensure residents needs are fully documented and their preferences known. Previous timescale 30/09/06 All medication received into the home must be recorded. This will safeguard residents by ensuring that medication is properly accounted for. All staff at the home must have training in safeguarding vulnerable adults. This will ensure that residents are protected. All staff at the home must have the required documents and information in place. This will ensure that residents are protected. Structured induction training that meets nationally recognised standards must be provided and recorded in staff training files. This will ensure that residents DS0000020019.V337164.R01.S.doc Timescale for action 06/07/07 2. OP9 13(2) 06/07/07 3. OP18 13(6) 30/09/07 4. OP29 19(1) 06/07/07 5. OP30 18(1)(c) 31/08/07 Hollin Knowle Version 5.2 Page 24 6. OP38 37 7. OP38 23(2)(b) are protected and are supported by competent staff. Previous timescale 30/09/06 Notification of deaths, illness and other events must be sent to CSCI. This will help to protect residents. Previous timescale 15/10/06 A copy of the up to date electrical safety certificate must be sent to CSCI. This will ensure the safety of residents. 31/08/07 06/07/07 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 OP9 Good Practice Recommendations Care plans should be reviewed monthly to ensure that details of residents’ needs and preferences are correct and current. Where handwritten entries are made on MARs, these should be signed by the person making them and countersigned by another person who has checked the entry is correct. This will protect residents and ensure that medication is given as prescribed. The range of activities should be improved and expanded to ensure that the needs and preferences of all residents are met. Records should be kept of ‘informal’ complaints, the action taken to address them, and of the outcome. This will ensure that residents concerns are taken seriously. The manager should continuously review staffing levels, taking into consideration the assessed dependency of residents and the layout of the building, so that residents are supported by staff in sufficient numbers to meet their needs. Staff should have training in the needs and care of people with dementia so that they are competent to meet the needs of all the residents at the home. A report should be produced of the analysis of quality assurance survey responses with details of action taken DS0000020019.V337164.R01.S.doc Version 5.2 Page 25 3. 4. 5. OP12 OP16 OP27 6. 7. OP30 OP33 Hollin Knowle 8. OP38 about issues raised. This will ensure that residents views are taken seriously and the home is run in their best interests. An internal communications system / phone should be considered so that staff can quickly summon help when needed. Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 © 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 Hollin Knowle DS0000020019.V337164.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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