Inspection on 30/05/07 for Holme House

This inspection was carried out on 30th May 2007.

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

The inspector 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 House 08/05/09

Holme House 22/05/08

Holme House 19/06/06

Holme House 24/10/05

Holme House 07/06/05

Holme House 02/12/04

Holme House 18/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

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 House Oxford Road Gomersal Cleckheaton West Yorkshire BD19 4LA Lead Inspector Bronwynn Bennett Unannounced Inspection 30th May 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holme House Address Oxford Road Gomersal Cleckheaton West Yorkshire BD19 4LA 01274 862021 01274871702 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) Milelands Ltd Michelle Rathbone Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under 65 years of age - DE category 19th June 2006 Date of last inspection Brief Description of the Service: Holme House is a care home registered to provide personal care and accommodation for up to forty, male and female, older people. It is situated in the Gomersal area of Kirklees fairly close to Birkenshaw, Birstall and the M62. The original property, which has been extended and modernised for its current use, retains some original features adding to its homely feel. There is ramped access to the front door of the home and stair lifts are in place to allow access to the ground and first floor. A passenger lift is also available. There are large, well-maintained gardens to the front and rear of the property where service users are able to sit when the weather permits. Car parking is available to the front of the property. The home’s pre-inspection questionnaire received by the Commission on 24.04.07 states that the weekly fees range from £335.24 to £380.00 per week. Additional charges are made for hairdressing, newspapers and toiletries. Information about the home and the latest Commission for Social Care Inspection report are available from the home. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit. The visit began at 9.00am and finished at 5.00 pm. During this visit the inspector spoke to people living at Holme House, visiting relatives, some staff, the home’s manager and the registered provider. The inspector read records of people’s care and staff records, looked at how medicines are given and looked at the accommodation available in the home. Prior to this visit the Commission for Social Care Inspection sent questionnaires to twelve people living at Holme House. Three questionnaires were returned. There were thirty-six people living at the home on the day of this visit. Surveys were sent to twelve relatives and four GPs. Five relatives and three GPs responded. Before we visited Holme House the manager gave the CSCI information about illnesses, accidents and incidents and how the home is managed The inspector would like to thank everyone for their assistance during this inspection process. What the service does well: This is the first visit to the home since it was taken over by a new owner in February 2007. The manager was registered with the Commission for Social Care Inspection in May 2007. No one moves into the home without having their care needs assessed. Two people that responded to the survey said they received enough information about the care home prior to them moving in. During this visit the staff were seen treating people living at the home in a dignified and respectful manner. Good relationships were seen taking place between the staff and people living at the home. The manager is working hard to ensure the staff are properly trained and able to care for people living at Holme House. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 6 There were some good comments made about the home during this visit. Everyone who responded to the survey said that they received the care and support they need. The manager is working hard to improve the quality of care being provided at the home. A relative who responded to the survey said the new management is making improvements. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are assessed prior to them moving into the care home. EVIDENCE: The care records looked at contained evidence of a social services assessment and a care needs assessment carried out by the care home as part of the admission process. Two people who responded to the questionnaire said they had received enough information about the care home before they moved in. and one person said a relative had chosen this care home on their behalf. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all health, personal and social care needs are set out in the individuals’ plan of care which means there is a risk of people’s health care needs not being fully met. The home’s medication policy and procedure does not sufficiently protect people living in the home. Generally people are treated with dignity, respect and privacy. EVIDENCE: The response from the surveys received by the CSCI show that overall people living at the home receive the care and support they need. Four responses from the relative’s surveys said the home met the needs of their relative. There were positive comments made such as “very good” and “needs are always met”. Two relatives responded that they were very satisfied with the care given to their loved one. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 10 Four individual care records were looked at. Since the last visit by the CSCI the manager has taken action to improve the quality of the care records kept. While the inspector recognises that the manager has strived to make improvements to people’s records, there are gaps in the information that is required to ensure the care needs of all individuals are met. One of the care records contained some good information about the person’s care needs, and showed the involvement of their relative. However, it required further detail regarding the assistance they required in order that they are safely supported with movement and handling. For example, where a movement and handling assessment shows an individual is at risk of falls or need the assistance of staff and use of moving equipment, such as a hoist, then a detailed manual handling plan must also be available in the care records, to ensure the staff are provided with the correct information and people are moved safely. Two of the care records looked at had not been updated. One of the care records had not been reviewed for over a year and the other over four months. This is not acceptable and does not give up to date information about peoples care needs. Up to date nutritional risk assessments and assessments to measure an individual’s risk of developing a pressure sore were seen in two of the care records. Two records did not have nutritional assessments. This information must be recorded in all the care records kept by the home. Where fluid and dietary needs are being monitored, the staff must be given clear instruction of what is a sufficient intake. The required amount of diet and fluids must be measurable so that staff are aware of when to seek medical advice. There were no up to date records of peoples’ weight. One care plan for eating and drinking clearly stated the individual must be weighed monthly. This action had not been carried out by the staff. During discussion it was evident that the individual did require their weight monitoring, as this would provide the relevant professionals, such as their doctor and dietician with up to date information. One person did not have a care plan for personal care needs. Two other records looked at did not provide sufficient information to ensure they reflected the choices made by the individual as to how they would like to be cared for. Any care plan should be developed with the involvement of the individual if possible or their representative. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 11 The content of the daily records kept was poor. The purpose of individual daily record is to reflect the individuals’ care plan, show what care and support has actually been given and show how each person has spent their day. The overall standard of the care records was discussed with the manager. She has agreed to take action and address all the issues raised during this visit. In addition to ensure all the care records are reviewed and brought up to date as soon as possible. The medication for four people was checked. One record was accurate. Some medication had not been carried forward from the previous month onto the current medication record. The manager agreed to take immediate action to rectify the matter. PRN (as and when required) medication such as Paracetamol had not been recorded on the current medication record, but was recorded on a separate record. This is not good practice. All medication that is prescribed by a person’s doctor should be recorded on the individuals’ medication record, complete with the instructions for its use. The manager said this would be dealt with through an audit of all PRN (when required) medication. Throughout this visit the people living at the home were seen being treated in a dignified and respectful manner by the staff working at the home. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people’s cultural, religious, social needs are being met. The appointment of an activity worker will meet individual recreational needs. Individuals’ are supported to maintain contact with their family and friends. People are able to exercise choice and control over their lives. The home provides the people living at the home with a varied and nutritious diet. EVIDENCE: During this visit there were many visitors to the home, who were all greeted warmly by the staff. During this visit the inspector saw that people were left for long periods in the lounge areas. This was discussed with the manager who said they try to provide another member of staff on each shift to meet the needs of people living in the home. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 13 The manager has identified a lack of activity in the home and this has been addressed by the appointment of an activity co-ordinator. It is expected that this worker will commence at the end of June 2007. The home aims to have individual social care plans in place in the near future. “Movement and music” visit the home on a monthly basis, and this activity was seen recorded in one of the care records looked at. During this visit there was some music playing in the lounges. One person spoken to said they were “bored during the day” One person who responded to the survey said they had spoken to the manager regarding activity in the home. There is a church service arranged in the home on a monthly basis and some people choose to go out to church. During this visit people were seen visiting the home. The manager said that there are no restrictions on visiting. Some people had chosen to go out with their friend or relative, and people are supported to go out into the community. People are supported to handle their own financial matters should they wish to do so and everyone is provided with lockable facilities in their rooms for privacy and safekeeping. The home is able to provide specialist diets such as blended and diabetic meals. The manager said that a food survey has been carried out and people were asked about their choice of meals. The meals served during this visit looked appealing and were well presented. All the people spoken to during this visit said they enjoyed their meals. The manager and the registered provider said they are looking at ways to improve the dining room arrangements. The home has worked well in addressing some individual care needs at mealtimes. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at home and their relatives are confident their complaints will be listened to and acted upon. Individuals are protected from abuse. EVIDENCE: The home has an up to date policy and procedure in place for dealing with complaints. Since the last visit by the CSCI the home has received four verbal complaints. The manager has taken action to rectify these issues and said her responses had been satisfactory. People spoken to during this visit said they would feel able to speak to someone if they were unhappy about something. A relative said that they would feel confident in raising any concerns. Everyone that responded to the survey said they knew who to speak to if they were unhappy, and knew how to make a complaint. All the staff working at the home has either received the training in the protection of vulnerable adults, or training is planned. The staff spoken to during this visit had a good understanding of necessary actions that must be taken should there be any allegations of abuse in the home. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people live in a safe and well-maintained environment. The home is generally clean and people have comfortable rooms with their own processions around them. EVIDENCE: Everyone who responded to the survey said the home is always fresh and clean. The home has an ongoing programme of maintenance. Since the last visit by the CSCI there has been some redecoration work and some comfortable chairs have been purchased. There are plans to provide suitable garden facilities for people to enjoy, and plans to update the dining room facilities. The registered provider said that plans to fit automatic door closers to all doors so that doors may be left open to assist people mobilise around the home. If the fire alarm Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 16 sounds the doors will close. This is good practice and will prevent some doors being propped open, which must be avoided at all times. There are three stairs near the main entrance to the home. These are a possible hazard to some people living at the home. This concern was raised with the manager. This area of the home should have a suitable risk assessment in place to reduce the risk to people living at the home and visitors. There have been some improvements in the laundry facilities. Washing machines are complete with sluicing facility, which promotes good hygiene standards. The home does have not have a sluicing facility to clean commodes. The manager said this matter is being addressed and these facilities will be in place imminently. The inspector accepts that the home has recently been taken over by a new provider and that time needs to be allowed to identify and carry out the improvements required at the home. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally staff are employed in sufficient numbers and receive training to ensure they are competent to do their jobs. Generally people are protected by the home’s recruitment practices. EVIDENCE: There were many positive comments received about the staff from both the people who live at the care home and their relatives. Two relatives said they were very satisfied with the overall care being provided, but one person commented that the staff lacked sufficient time to provide personal care of people. The manager said that the staffing levels are being increased to meet the needs of people in their care. During this visit people were observed being left for long periods in the lounge areas without a care worker present. This was discussed with the manager. Every effort should be made to ensure staff are available throughout the home and everyone is adequately supervised. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 18 The records for three staff were looked at. Generally these records contained the required information to ensure the way the home employs its staff protects people in they’re care. However, two records did not contain a full employment history. This was discussed at the time with the manager who agreed to take immediate action in the matter. The manager has taken action since she was appointed and planned a series of training days to ensure all the staff working at the home are sufficiently trained and able to carry out their duties to a satisfactory standard. Some staff have already received training in the protection of vulnerable adults, infection control, safe manual handling practice, food hygiene and first aid. All new staff undertake the homes basic induction training and “Skills for Care” induction standards. (Skills for Care is the national training organisation). There are eleven staff currently working at the home that have achieved the NVQ level 2 or above in care. The manager said that some staff are waiting to be registered for this training. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run and managed by a person who is fit to be in charge. Generally the home is run in the best interests of people who use the service. The financial interests of people living are safeguarded. Greater care must be taken to ensure the health and welfare of everyone is promoted and protected. EVIDENCE: The registered manager of the home is Michelle Rathbone. She is a registered nurse (RMN) and has ten years experience of working with older people and experience of work with people in the community. Ms Rathbone was registered with the CSCI in May 2007. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 20 The home has a quality monitoring system in place to ensure they are providing people with a good service. The registered provider visits the home and monitors the service. There are meetings for the staff, people living at the home and their relatives. In addition the home now has a newsletter to share information and keep people informed about events taking place at Holme House. Three individual finances and financial records were checked and were correct. People are supported to handle their own finances should they wish to do so and locked facilities are available in individual rooms. The fire records were checked. While there was weekly testing of the homes fire alarm system the emergency lighting was recorded as checked monthly. This is not acceptable. The manager agreed to address the matter immediately and ensure the emergency lighting is tested weekly to ensure all the system is working properly and people are protected. Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 13 14 15 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 2 3 3 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 X X 2 Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) Requirement The individual care plan must include all assessed and identified health personal and social care needs. Care plans must be detailed and kept under regular review. Nutritional assessments must be available in the individuals’ care records. Where fluid and dietary needs are being monitored, the staff must be given clear instruction of what is a sufficient intake. The required amount of diet and fluids must be measurable so that staff are aware of when to seek medical advice. Timescale for action 30/07/07 2. OP8 12 (1) 30/07/07 Holme House DS0000026273.V333502.R01.S.doc Version 5.2 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. 1. 2. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations The daily records kept for individuals should reflect the level of care being provided and how each individual has spent their day. Where a risk is identified, for example, falls, a care plan should be produced and detail how the risk is to be managed. The home’s medication policy and procedure should be fully implemented. Greater care is required with the PRN medication (when required) and safe storage of medicines in the home. The planned improvement for activity provided in the home should continue. A risk assessment should be put in place to further protect people living at the home and any visitors. The plans for installing a suitable sluicing facility should be actioned as soon as possible. The management should ensure that staff are deployed throughout the home to ensure that people are adequately supervised. Staff should continue working towards achieving NVQ level 2 certificate. Gaps in staff’s employment history should be explored as part of the homes recruitment policy and practice. The emergency lighting should be checked on a weekly basis. 4. 5. 6. 7. 8. 9. 10 OP12 OP19 OP26 OP27 OP28 OP29 OP38 Holme House DS0000026273.V333502.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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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