Inspection on 08/08/08 for Holmbury Dene

This inspection was carried out on 8th August 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmbury Dene 08/10/07

Holmbury Dene 18/05/06

Holmbury Dene 08/12/05

Holmbury Dene 29/04/05

Holmbury Dene 22/12/04

Holmbury Dene 02/08/04

Similar services:

Ashlong House

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Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOME ADULTS 18-65 Holmbury Dene 2 Lawrie Park Road Sydenham London SE26 6DN Lead Inspector Lynne Field Key Unannounced Inspection 8th, 20th & 27th August 2008 10:00 Holmbury Dene DS0000025625.V368039.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 Holmbury Dene DS0000025625.V368039.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. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmbury Dene Address 2 Lawrie Park Road Sydenham London SE26 6DN 0208 7787700 0208 7789437 holmburydene@hotmail.co.uk 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) PLUS (Providence & Linc United Services) Mrs Juliette Anne Hagan Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 8th October 2007 Date of last inspection Brief Description of the Service: Holmbury Dene is a very flexible service that has 54 service users who use the service on a needs lead basis over the course of a year. This means service users are able to stay for as short or as long a period of time as is agreed and / or needed either by them or their carers. It provides care for up to 10 people with learning disabilities at any one time. Three of the ten service users in residence may have a physical disability as well as a learning disability and or challenging behaviour. The support offered includes mental health and management of challenging needs. The home is staffed on a 24-hour basis, consisting of a manager, an assistant manager and full and part time support workers. Staff levels can vary depending on the number of service users staying at the home at any one time and the level of their support needs. The home provides respite care for service users who live in the community with carers and for service users awaiting a more permanent placement. The home is also the emergency placement and assessment centre for people with learning disabilities in Lewisham. It is a large, two and a half storey building close to Sydenham train station and local shops and services. The area is also well serviced by buses to central and south London. There is accessible off road car parking space for up to seven cars to the front and side of the building. The garden is accessible from the dining room. The ground floor is wheelchair accessible consisting of four single bedrooms, a reasonably sized kitchen, a dining room, a large lounge looking Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 5 onto the front of the building, one fully accessible shower room/toilet, one fully accessible bathroom and the staff sleepover room. The first floor contains three single bedrooms, two bathrooms /toilets, a lounge area and the staff room. There is also a self-contained flat on the first floor currently not used for accommodation. The second floor has a room that had been used for volunteers but was now vacant. The service is block funded by Lewisham Partnership and so information is not available with regards to monthly fees. Prospective service users are given information about the service via a Service User/Carer pack. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and was carried out over three days in July/ August 2008. The administrator facilitated the first day of the inspection because the registered manager was on annual leave. The service manager was present for part of the first day and at the inspection of staff records in the organisations head office. The registered manager was present and took part in the inspection process during two of days we spent in the home. We were able to speak the registered manager about aspects of the service they manage and about how the home was and would be developing. The inspection included a tour of the home and examination of records on care plans, medication records and the complaints book. During a tour of the home we met five service users, who said they liked living at the home and one parent whose relative had just started to use the service. We spoke to four care staff who told the inspector about their experience of recruitment and working for the service. The inspection also involved the case tracking of four people’s care, the assessment of a range of the home’s records, procedures and forms as well as observation and a tour of the premises. Service users came and went during the inspection and the inspector was able to observe that the interaction between staff and service users was friendly and respectful. The registered manager returned a standard form, the Annual Quality Assurance Assessment (AQAA), to CSCI. This was taken into consideration and used as part of the inspection process. What the service does well: This is a very busy service that offers much needed respite for families who live in the community. The registered manager and staff manages any challenging behaviour of the residents well and have a good understanding of how to defuse potentially volatile situations while treating the service users with respect and dignity. Due to the large number of service users that use the service it is very flexible and manages to keep up with the changes that will occur in that number of the service users lives well. The needs of service users are fully assessed prior to being admitted to the home. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 7 The service promotes independence for service users who have a range of disabilities and continues to offer good individualised specialist care for service users who need high levels of support. Service users who stay at the home for longer periods are supported to get involved in training/educational courses and to find employment. They also engage in a variety of leisure activities and generally to become part of and participate in the local community attending local day centres, going to restaurants, the cinema and using other local facilities such as the library and shops. Service users are supported to maintain links with family members and other appropriate personal relationships. Visitors are made to feel welcomed by staff. Service users individual food preferences and specific cultural needs are catered for and staff encourages service users to eat a healthy diet. The service continues to address the health and personal support needs of service users well with input from a range of different health professionals such as GPs, district nurses, mental health teams, speech therapists amongst others. What has improved since the last inspection? What they could do better: Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 8 Documentation and record keeping need to be more robust and accurate at all times. Care plans must reflect what has been agreed in reviews and with relatives and other professionals so staff can be clear what they are doing and why. Medication policies and procedures need to be followed to keep the service users safe from harm. Staff supervision must be held on a regular basis to ensure staff develop and follow the correct working practices and procedures. 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. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 9 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 Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents’ needs and aspirations are assessed, so that a service tailored to their needs could be provided. EVIDENCE: We saw the statement of purpose and the service user guide, which includes the complaints procedure. The service user guide gives information about the fees charged by Lewisham Social Services who have a block contract with the organisation. Service users stays are paid for by Lewisham Social Services who then invoice the service user or their family. The service user guide has been produced in an accessible format for residents using “Widget” picture graphics. We were told a full needs assessment would be carried out based on the personal history. A care management assessment would be completed to ensure the service could meet the prospective service users needs before a place at the service was offered. A risk assessment meeting which involves the service user, their carer, social worker, staff from the home and other relevant professionals, is held as part of the assessment possess and care plan development. There was evidence of the assessments on service users files we checked. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 11 We were told potential service users and/or their carers / representatives are invited to visit the home to look at the house. This gives them the opportunity to find out more about the service that is being offered. They are given a “Welcome Pack” that includes a service user information form that is used to gather information about the service user for the care plan folder and a carers’ agreement. Before the service user is able to stay over night each service user is invited to the house for lunch or tea visits to meet other service users and staff. Service user plans demonstrate that specialist services such as mental health services, specialist behavioural services, speech and language therapy, district nurses amongst others are accessed to ensure service users needs are met. We were able to speak to one service user who had recently started to use the service and their parent. They confirmed they had the opportunity to visit the service and had all the relevant information about the service before they came to stay. The service user and their parent both said they were happy with the service and the service user said, “they liked staying there”. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are involved in planning their care with their key worker, the registered manager, appropriate professionals and family members. At times the staff and families have failed in their communication with each other to the detriment of the service user. Potential risks are identified and residents are supported to take risks within a risk management framework. EVIDENCE: We checked four service user’s files that we case tracked. Two were of new service users who had recently started to use the service and two had used the service for some time. All were using the service at the time of the inspection. Service users’ care manager allocates a number of days the service user is able to use the service for based on a needs led basis. This takes into consideration the needs of the service user and the needs of their carer. This Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 13 means some service users could come in regularly each week/ month, while others may use the service very infrequently. As at the last inspection, it was identified that service user plans were based on information from the core assessments obtained from the local authority, that they contained a lot of detailed information about the personal, health and social care needs of individual service users and included interventions and individualised procedures to address aggressive and other forms of challenging behaviour. Although the registered manager said they are continually up dating the information. This is to ensure that the changing needs and personal goals of service users are clearly reflected on service users files. When we checked two files and not all information was as clear as it could be. This was highlighted by an incident we were informed about that occurred during the time of the inspection. An incident occurred relating to a service user where a relative thought the home had information about what would happen in a certain situation but this was not what the home actually held on file or what the staff of home did. Communication, of all types needs to be clearer and there need to be clear guidelines about what, when and how this is agreed, recorded and accessed. We saw copies of six monthly review meetings on the files inspected and were told the service is conducting its own internal reviews. The registered manager said they would include family and professionals in reviews and would ask them to sign care plans and support guidelines to indicate their involvement where possible. We saw copies of signed care plans and support guidelines on file. Care plans would be reviewed with the service user when they came for a stay and their carer would not be available to sign it had been reviewed. If the service user has not used the service for a number of months and the care plan is due to be reviewed, staff need to contact the parent/carer to ensure the service known about any changes that might have taken place since the last visit. As noted at previous inspections the local authority carries out reviews every six months with all service users and family members are invited to attend but these are generally held at the day centres or the main council offices. The registered manager said they always try to attend these meetings and will rota staff on to go to represent the home but sometimes at the last minute something prevents staff attending. As has been stated, this is important because as part of service users’ overall care, the home needs to ensure they are kept informed of the needs of service users and any changes. It is an opportunity for the service to up date the family and professionals about how the service user is progressing. The home has a key worker system. There was evidence that support workers had been allocated to work with individual service users and also that the role of the key worker and responsibilities involved have been discussed with staff as part of a team meeting. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 14 Service users are offered opportunities to participate in the day-to-day running of the home. They are supported by staff to make decisions about what they wanted to do for the day. One service user wanted to listen to their music and another service user said they would like to go out, so staff arranged to take them out. Service users are encouraged to help around the house and one was supported to do their laundry. Another service user said they wanted a drink and they were encouraged to go into the kitchen to make one for themselves. Service user meetings continue to be held regularly on a two weekly basis within the home. This means because of the nature of the service more service users are able to attend. Service users are encouraged to give their views on various aspects of how the home is run. In addition, there is a service user meeting held within the whole of the organisation in which service users from each home can attend. It was reported that one of the service users has been involved in this meeting and has also been involved in sitting on a recruitment panel. If a service user is interested in doing this the organisation gives them training and support to help them understand what the recruitment is about. Risk assessments are developed from the assessments and with service user involvement and these are reviewed at risk assessment meetings. The service user, their carer, social worker, staff from the home and other relevant professionals where possible are involved in reviewing the risks. Part of the services policy is that all staff have to sign that they had read the details of the risk assessment. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to take part in age, peer and culturally appropriate activities and are being given opportunities for personal development. Service users are supported to participate in the local community. The home supports and encourages service users to have appropriate personal and family relationships. A healthy diet is provided, which the service users enjoy. EVIDENCE: From the four files inspected we saw evident that service users are offered specialist interventions and opportunities by trained staff to help facilitate their personal development in respect to emotional and communication needs. We Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 16 saw staff encouraging service users to develop independent living skills by supporting them to assist in daily tasks around the home. The daily records demonstrated that they are regularly supported to be part of and make use of the local community and facilities such as shops, library, cinema pubs and restaurants. There was evidence within service user plans that service users are supported to find and keep appropriate jobs and take part in education or training and other fulfilling activities. Also, it was evident that the home values and seeks to reflect the cultural and racial diversity of service users with a balanced staff team working at the home. All service users have individual activity plans in place that detail all the activities that service users engage in during the week some of which are organised by the day centres where service users attend. These demonstrate that service users are engaging in appropriate leisure activities. There was also evidence from the daily logs that service users are engaged in other activities. We checked copies of daily records of the service users. These are kept by the staff who have worked with the service user on that day. We found one was not accurate and spoke to the service manager about this who said they did not know why this was but would investigate why it had happened. Staff need to be aware these records are legal documents and should be an accurate account of what has happened during that shift and completed at the end of each shift. See Standard 41. The home supports and encourages service users to maintain family links and friendships inside and outside the home. One service user has a friend in another home who they keep in touch with. Some of the service users attend the Gateway club. This is a social club where people with or without a learning disability can attend including family members and friends. The home does not have a planned weekly menu. Instead, individual service users are asked what they would like to eat for lunch and supper and this is then prepared. As there is a turn over of service users with individuals needs staying at the home, sometimes for short periods on respite, this arrangement does ensure that personal preferences are catered for and specific cultural needs are also met. A record of all meals eaten by service users is kept as part of their individual daily log. A sample of these was checked and there was evident service users are provided with a good variety of meals that were nutritious and balanced. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal support, in the way they prefer and their physical and emotional needs are met. The homes medication policies and procedures on the handling and administration of medication are not being followed at all times. Service users could be put at risk when the procedures for the handling and administration of medication are not followed. EVIDENCE: Information collected at the pre admission assessment and during the homes assessment of the service user goes towards developing the care plans, which involves the service user and their carer. All four care plans viewed curing the inspection contained detailed information and guidelines on all aspects of personal support and care required by service users including personal preferences around personal care, eating and drinking preferences, individual communication needs, mobility needs and managing behaviour presented by service users. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 18 It was clearly evident from service user plans and within the daily logs that service users physical and emotional needs are being well met with regular liaison with a range of healthcare professionals including mental health teams, physiotherapists, G.P’s, speech therapists, district nurses, dentists, chiropodists amongst others. Appointments relating to service users health needs are recorded on a Medical Report form. In addition in relation to service users individual health needs there was evidence of monitoring of pressure areas, fluid intake and an epilepsy monitoring form. We were told interim service users are offered an annual health check and they hope to extend this to include all service users who use the respite service. The home has a robust medication policy and procedure. There are individual procedures in place that have been agreed with individual relatives and carers, but all medication should be checked and counted before the relative leaves the home. If there are any discrepancies or changes to the medication this can be discussed and the mar chart amended. We were told that only permanent staff administer medication and that they have all received training from the local pharmacist. None of the service users living at the home at the time of the inspection were administering their own medication. Staff said when a service user came to stay, all their medication was checked, counted and recorded on the MAR chart. It had to be in the original correctly labelled container other wise they would be unable to give it until they had checked with the GP or family carer. A stock check is done each night. We checked four service users medication and found discrepancies in the records, which indicated the medication had been wrongly administered. We reported this and spoke to the service manager who was at the home at the time of the inspection. Medication must be correctly administered at all times and staff need to follow the correct procedures to do this. The service manager said medication training was part of the induction training. When we met the registered manager on the second day on the inspection she told us she would go through the medication procedures again with staff at the end of the induction and training to check they were following the correct procedures. Both staff and the registered manager said the local pharmacist came to a team meeting to do refresher training with them. The homes medication procedure and practice is checked on a regular basis by the local community pharmacist team. The registered manager told us that homes managers carry out internal spot checks of the medication each week. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure, which is also in an accessible format for service users. There are comprehensive adult protection procedures and a whistle blowing policy in place to ensure service users are protected from abuse. CSCI have been informed immediately when incidents occur. EVIDENCE: The service has a robust complaints procedure that includes the stages of, and the timescales for the process. This is also in a format accessible to service users with “Widget” picture graphics being used. A copy of this complaints procedure was seen to be placed on a notice board which is visible to service users. In addition, it was noted that within the service user plans that were inspected as part of a carer’s agreement, which is signed, a copy of the complaints procedure is issued to the main carer. There was also evidence from the minutes of service user meetings that service users are encouraged to voice any concerns they may have about the home. The home keeps a log of informal and formal complaints. We were able to view this. There was one complaint and one came in during the time the inspection was taking place. The complaint had been investigated and there were notes, which provided details of the complaint. The complaint that came in during the Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 20 inspection was being dealt with in an appropriate manner and all professionals were kept informed and the registered manager and the organisation started an investigation. This is ongoing at the time of writing the report. Since the last inspection notifications about complaints and reports regarding complaints being made are being sent to CSCI. We spoke to the service users relative we met at the home who said they knew who and how to complain to if they needed to. We spoke again to the service user who lived at the home permanently and they said knew when and how to make complaints if needed. They said any concerns they had they would speak to the manager or a member of staff. The home has robust policies and procedures on adult protection and whistle blowing. One referral under the safe guarding adults and this is being investigated at the present time. The registered manager has kept us informed and we received copies of the statements made relating to this case. We were told all new staff attends training on safeguarding of vulnerable adults as part of their induction. Other staff we spoke to said they receive training and records held on staff files confirmed this. The home also has a comprehensive policy regarding the management of service user finances. We checked the money held by the home for service users who were staying at the time of the inspection. Staff told us this was checked at every handover shift and signed for. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, well maintained and comfortably furnished with adequate private and shared space. There are good facilities and adaptations available to meet a range of service users needs. Recent redecoration and adjustments have improved the facilities and further improvement work is planned. EVIDENCE: The home provides accommodation for one permanent placement, and for short and long term stay. The home is spacious, comfortable and generally well decorated and maintained and the size of the building allows for service users to access different areas of the house. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 22 We found the home was very clean and free from offensive odours on each of the days of the inspection. The home is cleaned daily by staff and service users (where appropriate), there is also a cleaning contractor who visits on a weekly basis to concentrate on cleaning specific area of the house on a rotating basis. The registered manager gave us a tour of the home and she spoke about the improvements the organisation had made and intended to make as well as how the organisation hoped to develop the service. Since the previous inspection some bedrooms and the living areas have been redecorated. The kitchen has been decorated and refurbished to make it easier for service users to use and there is a small fitted kitchenette. We were told the home hopes to purchase some profile beds for the bedrooms and new armchairs for lounge. The home has lots of shared space that service users are able to use. The entrance hall is large and welcoming with a seating area. There are three lounges / dining rooms and a sensory room. One lounge is known as the quiet lounge where service users can sit quietly and relaxing. We were told they are changing the use of some of the rooms. This will create specific areas to which provides specialist support for particular groups of service users. For the duration of their stay all service users are provided with their own bedroom. One service user, who lives in the home permanently, is hoping to move to a larger bedroom within the home that will be more suitable and meet their changing needs. The registered manager said the room has been decorated in the colours they have chosen. Because they live there permanently they have brought in their own possessions, which made the bedroom their own and this has a homely feel to it. Each bedroom is comfortably furnished but as was stated in the last report, because it is a respite service some bedrooms do not have a homely feel because of lack of personal possessions. The home has four bathrooms with toilet and one ground floor bathroom is fitted with a bath lift. In addition, the ground floor has a walk in shower room, with toilet facilities, a portable universal shower chair and portable table. We were told the ground floor bedrooms are given to service users with the higher mobility needs. There are some adaptations to the home to assist service users who have physical disabilities. Two hoists are available for service user requirements. The home has good laundry facilities and an adequate policy and procedure for control of infection. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff working at the home to meet the needs of the service users Recruitment arrangements are good and residents individual and joint needs are met by appropriately trained staff. Staff are receiving training to enable them to meet the joint and individual needs of service users. Formal supervision needs to happen for all staff on a regular basis. EVIDENCE: We spoke to two service users and one relative in depth during the inspection. They told us they like the staff and found them helpful. We observed staff interacting in a respectful way towards the service users and demonstrated by their actions and responses they knew the service users well. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 24 We spoke to four staff, the service manager, the registered manager and the administrator, observed staff working and looked at the staff rota. During the inspection it was observed that there were sufficient numbers of staff on duty. Both the staff and the registered manager said the number of staff on duty was determined by the needs of the service users they had staying in the home at that time and this could fluctuate if service users needed “one to one” support. The registered manager is constantly reviewing staffing levels. The organisation keeps the main staff files including the recruitment records at the head office. As part of the inspection process we visited the organisations head office to check recruitment practices and staff files. We checked three staff files and found they all had an employment contract, which includes details of their terms and conditions of employment that they had signed. The home protects residents by obtaining references, CRB Enhanced Disclosures with relevant POVA checks were present for each staff member. We were informed earlier this year that the organisation had worked with the Home Office in relation to staff whose immigration status was in question re working permits/passports. As a result a number of staff were removed from the service. Staff have two weeks induction. The first week is at the organisations head office before they go to the home for the second week of the induction at the house they will work in. Mandatory training includes manual handling, food hygiene, infection control, first aid and other general health and safety training and this is updated as required. We contacted the organisations training department and they were able to confirm staff in the home had completed a wide range of training and that mandatory training takes place each year. This is an up to date record of all the training undertaken by the staff in the home. This included individual staff training records that confirmed staff have completed mandatory training such as manual handling, food hygiene, first aid among others. There was evidence of an annual training plan that included mandatory training to ensure that this is regularly updated. There was evidence from records that staff have completed a variety of courses to ensure that staff are able to meet the specific and joint needs of service users including understanding epilepsy, skills teaching, management of aggression, autism, cerebral palsy, adult protection and diversity and equal opportunities. Staff we spoke to confirmed that they received supervision and had annual appraisals. The staff said they felt they could talk to their manager whenever they are around. Copies of staff supervision notes, which are signed, by a manager and a staff at the end of the supervision to confirm the goals set in a meeting are kept locked in the staff office. We checked staff files that are kept in the home that contain the records of training and supervision. There was evidence of supervision but not that it was happening regularly. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 25 Regular staff meetings are held. Minutes of the meetings were seen that indicated a good range of topics are discussed including issues in relation to service users, staffing issues and general matters relating to the day to day running of the home. The registered manager said she sometimes had impromptu staff meetings where if an issue had arisen that needed to be addressed immediately she would gather them together and discuss it. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well run and managed. The registered manager is qualified and experienced and runs the home well. Working practices and associated records need to be more robust to ensure that the service users health and safety and well being are maintained. EVIDENCE: The registered manager has experience of managing services and working with adults with disabilities. She is working towards NVQ level 4 in Management. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 27 We spoke to the registered manager at length on two days of the inspection. One area of discussion was around staff record keeping and following policies and procedures. The registered manager discussed how these shortfalls would be addressed by the organisation and the checks that they will put in place to ensure the home complies with the requirements to meet the shortfall, such as monitoring procedures she will oversee herself. We observed during the course if the inspection she acted in a professional and conscientious in her approach to her work and her interaction with the service users and staff. Staff and service users said they have confidence in the registered manage and felt their views were listened to at service users meetings and staff meetings. One professional we spoke to said “they had enormous respect for her and the work she does”. One new service users relative said they liked the home and felt happy and confident to leave their relative in the home. They said they felt they could speak to the manager and staff about any concerns they had at any time. There a business plan that states how the home aims to improve over the next year. The registered manager has regular meeting with senior and executive management, to discuss and plan the homes requirements. We were told the home is using the self-auditing system called a “Practical Quality Assurance Systems for Smaller Organisations (PQASSO)”. The work on self-auditing has begun. As part of the home quality assurance questionnaire are sent to service user and carers. The results from this were not available on the day of the inspection. The registered manager reported that all staff have been inducted around how to implement the system. The home has policies and procedures in place around health and safety. The records we saw indicated the homes health and safety services and equipment have been checked, serviced and maintained at the appropriate intervals. There was a copy of the fire certificate floor plan and risk assessment on file. The break alarms are being tested weekly and fire-fighting equipment has been checked regularly. Fire drills have been carried out with service users at various times of day on different days, ensuring all staff have taken part in fire drills over the course of six months and there is a record of the date and time drills have been carried out. The organisation has recently updated the procedures for carrying out a comprehensive risk assessment with services. As well as the home being visited regularly by the organisation management for a Person in Control Inspection there are regular in house health and safety checks. Copies of the reports and records of the checks are kept at the home. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 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 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 32 33 34 35 36 2 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 X 3 X 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000025625.V368039.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holmbury Dene Score 3 3 2 x 3 3 3 X 2 3 X Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) Requirement The registered person must ensure there is more up to date information in the care plan and staff, residents, their families and professionals involved with the service user all know and agree with what is written in this. An up to date copy of the care plan given to the service users family to agree. The registered person must ensure that the homes medication policies and procedures are followed at all times. The registered person must ensure that staff working at the home have regular supervision. The registered person must maintain accurate records in respect of service users daily records and other records specified in Schedule 3. Timescale for action 30/09/08 2. YA20 13(2) 30/09/08 3. 4 YA36 YA41 18(2) 17 Sch 3 (3)(i) 30/09/08 30/09/08 41 Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 30 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 YA39 Good Practice Recommendations The registered person should draw up the customer satisfaction surveys for service users in a more accessible format. Holmbury Dene DS0000025625.V368039.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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