CARE HOMES FOR OLDER PEOPLE
Holly Bank Holly Bank The Promenade Arnside Carnforth Lancashire LA5 0AA Lead Inspector
Jane Strawbridge Unannounced Inspection 29 September 2005 1:30 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 Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holly Bank Address Holly Bank The Promenade Arnside Carnforth Lancashire LA5 0AA 01524 761227 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) Agis Residential Care Homes Ltd Manager post vacant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 31 service users to include: up to 31 service users in the category of OP (older people) The home should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 3/3/05 Date of last inspection Brief Description of the Service: The home is situated on the promenade in the coastal village of Arnside and has views over Morecambe Bay to the Lakeland fells. The building comprises a pair of semi - detached Victorian villas that have been combined, adapted and extended for its current purpose. The residents are accommodated on all three floors which are served by a passenger lift. The building is well maintained and there is a small car park at the rear of the building. There are ample communal areas including a conservatory and sunroom. There are 27 single bedrooms; 18 of which have en-suite facilities, and two double bedrooms. The village has a range of shops and a post office within a short walk from the home. Public transport is available in Arnside for people who wish to use the rail, bus or taxi services. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of the home took place during an afternoon. Ms Ann Mason Denny the home’s Acting Manager, and Ms Cath Whitehead the Marketing and Operations Manager for Aegis Residential Care Homes Ltd were present throughout the inspection. Time was spent talking with the residents either in small groups or individually, with their visitors and with the staff on duty. We looked at records to do with the care of the residents and the dayto-day running of the home, and visited all parts of the home. What the service does well: What has improved since the last inspection?
Managers working for Aegis Residential Care Homes Ltd have used internal audits to identify what changes are needed to improve the quality of the care and accommodation. Work to upgrade the accommodation has already been completed to provide two en-suite bathrooms, decoration to other bedrooms and new carpets. This has resulted in brighter and more pleasant living space. Staff have benefited form the conversion of a small bedroom into a staff room. The service user guide has been reviewed and redesigned to enable people with visual impairments to read it more easily. The home has invested in new training programmes so that all staff are properly trained and competent to care for the residents. Additional measures have been put in place so that residents are protected from harm. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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 Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 The home uses an admission procedure that means a proper assessment takes place before people move into the home. This practice together with the information given to prospective residents ensures that care needs can be met. EVIDENCE: The acting manager and senior carer visit prospective residents to assess their needs and to see if the home is suitable for them. They obtain as much relevant information as possible from the person and their family and carers. In return they provide information about the home to help each party to make an informed decision about moving in. The standard of the information given to residents prior to them moving into the home has improved significantly since the service users’ guide has been reviewed and reprinted in large text. This has made it easier for people to read and understand, confirming the range of information given at the time of the pre–admission assessment. Residents said they appreciated knowing about the home before visiting because they “had some idea of what to expect.” Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Residents’ health care needs are identified, recorded and met in a way that respects their dignity and privacy and safe practices ensure the residents are protected from harm. EVIDENCE: All residents have a comprehensive plan of care. Information in the care plans together with up to date risk assessments enable the care staff to ensure the correct level of care is available and given to each service user. There are plans to introduce a new care planning system to involve residents and their families. An area on the ground floor has been converted into a new treatment room where all medication is stored securely. Individual photographs have been attached to the relevant records and a new stock rotation system has been introduced. Regular internal audits and monitoring by the local pharmacist ensure that there are safe procedures for the storage, handling and administration of medication. The medication records were correctly and neatly completed and all staff with a responsibility for administering medication had completed the appropriate training. Members of staff on duty were seen to behave in a professional manner showing respect and courtesy for each of the residents. This was confirmed
Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 10 during conversations with residents who said “the staff are very kind and we can have a laugh and a joke” and “ I am glad I moved here.” Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 There is a relaxed and friendly, welcoming atmosphere in this home. Meals are balanced and nutritious to offer a healthy variety of food that meets the residents’ tastes and choices. EVIDENCE: Holly Bank has an open door policy where visitors are welcome at any time. Residents can see their visitors in private in their room or in communal spaces away from the main lounges. Many residents lived in Arnside or nearby before moving into the home and they said that family members and old friends kept them in touch with what is going on locally or in their home village. Some residents said they went out on their own or with family and friends. Menus are changed regularly, providing a well balanced, varied and appealing diet with a choice available at all meals. Meals are served in the dining room or in the resident’s own bedroom dependent individual preferences. Residents said that “the food is good here” and “we all look forward to our meals.” There are plans to improve standards in the dining room and to introduce a ‘hotel style’ meals service to allow more choices Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents in this home are confident that any concerns they may have are taken seriously and dealt with. The home has a procedure to protect people from harm. EVIDENCE: All residents spoken to said that they knew who to speak to if they had a concern or complaint. They said that they expected any concern to be taken seriously and acted upon. The majority said they did not have anything to complain about. However one resident had a concern that was raised with the acting manager during the inspection and a solution was agreed. Staff had been given training on how to respond to any suspicion or allegation of abuse. This subject is covered in the staff induction programme as well as during staff supervision. The home had policies and procedures in place together with Cumbria’s Adult Protection Policy for staff to refer to if needed. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 The new owners have invested in a refurbishment and redecoration programme to improve the standards of accommodation for residents. EVIDENCE: Some bedrooms have been upgraded and residents said that they were happy with their newly refurbished rooms and were especially pleased that they had their own en-suite facilities. They said how much they appreciated the opportunity to bring with them small pieces of furniture and personal possessions to make their bedrooms homely and comfortable. Some structural alterations have taken place to convert unused space on the ground floor into a fully equipped treatment room. A hairdressing room was being developed nearby to create a welcome new facility. There are plans to redecorate and fit new carpets into the communal living spaces and the reception area to make them brighter and more comfortable. The home was clean and tidy and residents said that the housekeeping staff worked hard to maintain high standards and “it is always like this.”
Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. The numbers of staff on duty during the day and night are sufficient to meet the needs of the residents. EVIDENCE: Residents said the staff were kind and caring and they responded quickly to calls for assistance. The acting manager is able to call on a professional team of trainers who identify individual staff training needs and deliver a training programme to cover these needs. The staff who were on duty were observed working competently with residents and colleagues. Residents confirmed that they were happy with the way in which staff provided personal care for them. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 The acting manager provides adequate direction, guidance and leadership for the staff so that residents are given consistent quality care. There are procedures and practices in place to ensure the health and safety and wellbeing of the residents, staff and visitors. EVIDENCE: The acting manager has completed NVQ level 4 in Management and Care and has significant experience in senior management in residential care. The marketing and operations manager visits the home several days each week to support the acting manager in her new role. Areas of responsibility and accountability were clearly defined. The new owners use an annual survey to ask residents and other interested people for their views on the quality of the services provided by the home. Some residents would like to be able to comment more frequently than once a
Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 16 year and would like to do so less formally. They said they would like to be asked for their views rather than wait to make a complaint. The manager should look at ways in which residents can be involved in making their comments about things that affect their quality of life. Staff members are supervised “on the job” and at handover sessions between the shifts. Matters were addressed as necessary to ensure safe and appropriate working practices. Additionally all care staff are given formal supervision at least six times per year. Staff had been given training to protect themselves and residents from harm. This training included moving and handling, infection control, fire training, food hygiene and first aid. Records showed that risk assessments had been undertaken to identify potential and actual hazards and actions taken to ensure the health and safety of everyone living, working and visiting the home. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 17 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP33 Good Practice Recommendations The manager should look at ways to actively seek the views of residents. Holly Bank DS0000063598.V261976.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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