Inspection on 28/02/06 for Holme Farm Care Home

This inspection was carried out on 28th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holme Farm Care Home 01/08/07

Holme Farm Care Home 04/08/06

Holme Farm Care Home 15/11/05

Holme Farm Care Home 20/01/05

Holme Farm Care Home 10/08/04

Holme Farm Care Home 30/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Holme Farm Care Home 9 Church Street Elsham Brigg North Lincolnshire DN20 ORG Lead Inspector Ms Matun Wawryk Unannounced Inspection 28h February 2006 09:30 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 Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Holme Farm Care Home Address 9 Church Street Elsham Brigg North Lincolnshire DN20 ORG 01652 688755 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) residential_home.elsham@fsmail.net Mr Anthony John Steeper Mrs Janet Steeper Mr Anthony John Steeper Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Registered Manager commences the Registered Managers Award and NVQ level 4 in Care before 31st October 2005. 15th November 2005 Date of last inspection Brief Description of the Service: Holme Farm is situated in the small village of Elsham. The home has open views across fields and fishing ponds and very pleasant accessible gardens. The home is registered for 20 male/female service users over the age of 65 years. The home is well maintained and provides a very homely environment. The service users accommodation is on one level and bedrooms are all single occupancy. Three of the bedrooms have ensuite facilities. The home has two lounges and a dining room. The home does not offer nursing care. Service users health needs are met with the assistance of other health care professionals for example general practitioners and district nurses. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the 28th February 2006. Throughout the day the inspector spoke individually to five people who lived in home and had lunch with a small group of service users. Inspector spoke to the manager, a senior carer and two care workers who were on duty at the time of the inspection. In addition the inspector also looked at a range of paperwork and records including staff recruitment, supervision and training records, the staff rota and a sample of care plans. The inspector also completed a tour of the building. What the service does well: What has improved since the last inspection? The manager had ensured the cook had completed a basic food hygiene course. This was needed to meet health and hygiene requirements. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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 Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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): Key standard 3 and 6 were assessed at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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, 8, 9 & 10 Some care plans did not include all the information staff need to meet the service users assessed needs. The absence of important information potentially puts service users at risk and means all their care needs may not be met. Personal support is offered in such a way as to promote and protect the service users’ right to privacy and dignity. EVIDENCE: The inspector case tracked three service users and spoke to five service users individually. In addition the inspector also spoke to the daughter of one service user. All of the service users spoken to confirmed staff respected their privacy and dignity. The care planning documentation was detailed and comprehensive. The home had risk assessment tools for nutritional, manual handling and a separate tool to assess pressure area risks. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 10 One recently admitted service user did not have any care plans. Daily records indicated some assistance with personal care was needed. Risk assessments indicated moving and handling issues. The records for another service user had not been updated to reflect recent changes in the service users care needs. Records examined indicated, following a period of ill health the service user was more dependent on staff for moving and handling and personal care. The registered person must ensure care plans are in place for each service user. Care plans must be revised to reflect changes in needs. This is needed to ensure staff have access to all the information they need to care for service users properly. All the service users were registered with a GP. Individual plans and discussions with staff and service users showed that the health care needs of the service users were generally being met and that service users had access to health care services as required. A record of health screening and visits to and from health care professionals was kept for each service user. The home had a range of risk assessment tools for example, manual handling, water low and nutritional screening. Generally these were well maintained although some deficiencies were noted. The moving and handling assessment for one service user had not been updated to reflect a change in needs. Similarly records for another one service user did not accurately identify all care needs. Daily records indicated the service user had a pressure sore and was receiving district-nursing support. General guidance for the management of pressure areas was available in the service user’s file. This standard format does not reflect, nor promote a personalised approach to care delivery. The inspector advises that for those service users at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice for example, they should set out in detail tasks staff are expected to carryout for that individual e.g. where ‘regular’ positional changes are advised care plans must be more specific in terms frequency, manoeuvres and monitoring arrangements etc. A policy and procedure for the safe handling of medication was available in the home. The systems for the safe handling of medication were examined. Records had been maintained for the receipt, administration and disposal of medication and there was a procedure for handling and recording receipt and return of medications. The inspector examined a sample of medication administration records. These were found to be in good order no errors or omissions in recording administration of medication were noted. Staff with responsibility for medication administration had been provided with medication training. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 11 Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The home provides flexible daily routines and some activities are provided. Service users are encouraged and supported to maintain family links and friendships. The meals in the home are good offering choice and variety. EVIDENCE: A list of arranged activities was not display in the home. Staff reported that activities provided included, sing-a-longs, visiting entertainers, trips out, hand massage and nail care etc. In discussion most of the service users spoken to said they were generally happy with the activities provided in the home although two service users commented they sometimes get bored. The inspector examined a sample of service users care records. Social profiles, had been completed, however in some cases staff needed to look in more detail at peoples social stimulation needs in order to tailor daily activities to individual wishes, needs and capabilities. Staff had not had any particular training in organising and arranging activity programmes. The registered person should continue, on a regular basis, consult service users about the programme of activities on offer in the home and consideration should be given to providing staff with some training in planning and organising activity programmes. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 13 Service users spoken to said daily routines were flexible. Service users confirmed that they were able to choose how to spend their day, what clothes to wear and which visitors to receive. There were no set times for rising or retiring. Staff reported that they helped service users to maintain family contacts by sending cards at significant occasions such as birthdays and Christmas and supported service users on outings. This was confirmed in discussion with service users. The inspector also spoke to the daughter of one service user, who reported that she was very happy with the care and support provided to the mother. Meals are served in the comfortable dining room. Meals can also be taken in other areas depending on the personal preferences of the service users. Service users spoken to reported they were very happy with the meals provided stating they had choices at mealtimes and food and drinks were in plentiful supply. Fresh fruit and vegetables are available. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home had a satisfactory complaints procedure. Service users, their relatives and staff can be assured their complaints will be listened to and acted upon. The arrangements for handling allegations or suspicions of abuse must be improved through the provision of staff training. EVIDENCE: The home has a detailed complaints procedure, a copy of which was on display in the home. Service users and staff reported understanding of the procedure. All staff and residents spoken to knew whom to contact to make a complaint. No complaints had been made to the home since the last inspection. The inspector was advised the home had a copy of the Local Multi-Agency Adult Protection Policy and Procedures Manual. An internal adult protection procedure and whistle blowing procedure was also available. Since the last inspection one adult protection referral had been made to the local authority. Examination of staff training records and discussions with the manager, highlighted staff had not had specific adult abuse training. This is needed to ensure staff fully understand and are able recognise potential abusive practices and to ensure staff are fully aware of their responsibilities and reporting arrangements. The remains an outstanding requirement from the last inspection. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 15 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): Key standards 19 and 26 were assessed at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staffing levels are sufficient to meet the needs of service users. The arrangements for vetting staff before they start working in the home do not ensure the safety and protection of service users. Staff training arrangements are generally satisfactory, however staff must be provided with essential mandatory training. This is needed to ensure the health, welfare and safety of service users and staff. EVIDENCE: Staff interviewed were very clear about their roles and responsibilities and understood the management and reporting structures for the home. Feedback from staff and examination of the rota indicates staffing levels are generally satisfactory. The home does not as yet assess staffing needs using the Department of Health Guidelines. All the staff spoken to said staffing levels were satisfactory. Service users reported staff answered call bells promptly. The registered manager should continue to monitor dependency levels and adjust staffing levels accordingly. The inspector examined the personnel records for two workers employed since the last inspection. The majority of records required by regulation 19 of the Care Homes Regulations were available. For example, Pova first checks had been sought and satisfactory Criminal Records Bureau checks had been obtained. However there no written references had been obtained for one Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 17 worker and only one written reference had been obtained for the second worker. Failure to follow sound recruitment practice potentially places service users at risk and this practice must cease. The registered person must ensure all required records including two written references are obtained before staff commence working in the home. The home maintained individual staff training records. Examination of a sample of records revealed staff had accessed a variety of training. However records examined did not evidence staff were fully up to date with all areas of mandatory training particularly manual handling. This potentially put service users and staff at risk and training must now be provided. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38 The management arrangements for the home are satisfactory and a quality assurance programme is being developed. The management of health and safety must improve through the provision of essential mandatory training. EVIDENCE: From records and discussion with staff and service users it was evident the current manager has worked hard to improve many of the systems in the home. All of the staff and service users spoken to stated the manager was efficient, approachable and effective. A Condition of Registration for the manager to complete NVQ 4 has not been met within the required timescale. The manager gave an assurance that he would completed the award this year. Mechanisms were in place for the manager to provide and receive feedback from staff and service users through meetings, handovers and informal Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 19 contacts. Staff and service users said the manager was very accessible and that they were able to relate to him in a positive way. The home had systems in place to monitor the quality of services provided and this includes regular audits and surveys. The inspector was advised a survey questionnaires had been issued to staff, service users and their relatives. A summary report setting out the outcomes these and other quality mechanisms had not yet been produced. The registered person must produce and make available a quality assurance plan. A summary of which should be included in the service user guide. There were comprehensive procedures in place for health and safety. Examination of a sample of staff training records revealed a number of staff were not up to date with all areas of mandatory training including manual handling training. The registered person must ensure all staff are provided with and up to date with all mandatory training, this is needed to meet health and safety requirements and must happen. Service certificates were in place for the gas and hoist. The hot water, emergency lights and fire alarm was monitored regularly and records seen during the inspection were satisfactory. Portable appliance testing (PAT) had been carried out. A current insurance certificate for the home was available and was displayed prominently in the home. There were no records to show that a maintenance check had been carried out on the home’s call bell system. The manager reported the system was safe and in good working order. A current maintenance certificate was not available for the home’s fire system. The registered person must ensure a check is carried out. Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X X X 2 Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 21 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. 1. Standard OP1 Regulation 4&5 Requirement The registered person must update the statement of purpose and service users guide to reflect the management changes. Timescale of 31.0.2005 and 31.12.05not met The registered manager must complete NVQ 4 in management and care. Timescale of 31.12.05 not met The registered person must ensure care plans reflect all areas of identified need including social, emotional, health and psychological health needs. Timescale of 31/12/05 not met The registered person must ensure staff are provided with adult abuse training. Timescale of 31.1.06 not met The registered person must ensure staff do not commence working in the home until two satisfactory references have been obtained. Timescale of DS0000002905.V264116.R01.S.doc Timescale for action 30/04/06 2. OP31 9 30/09/06 3. OP8 15 30/04/06 4. OP18 13 30/04/06 5. OP29 19(1)(b) 28/02/06 Holme Farm Care Home Version 5.1 Page 22 30.11.05 not met 6 OP38 13 The registered person must ensure all staff are up to date with all areas of mandatory training for example fire safety, health and safety and infection control The registered person must ensure staff responsible for completing service users risk assessments are provided with relevant training. Training must be linked to the areas of risk being assessed. Timescale of 28.2.06 not met The registered person must produce and make available a quality assurance plan for the home. A summary of which must be included in the service user guide The registered person must arrange to have a maintenance check carried out on the homes fire system The registered person must ensure staff are provided with manual handling training. Timescale of 31.12.05 not met The registered person must ensure for those service users at risk of developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice. The registered person must ensure a care plan is developed for service user A. 31/05/06 7 OP38 13 30/04/06 8 OP33 35 30/05/06 9 OP38 13 30/04/06 10. OP3 18(1)(a) 30/04/06 11 OP8OP7 15 03/03/06 Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holme Farm Care Home DS0000002905.V264116.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!