Inspection on 22/11/05 for Holme View

This inspection was carried out on 22nd November 2005.

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 View 30/07/08

Holme View 21/08/07

Holme View 30/08/06

Holme View 18/01/05

Holme View 14/10/04

Holme View 17/03/04

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Snydale Care Home

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The Grove Waltham

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Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Holme View Gillingham Green Holme Wood Bradford BD4 9DT Lead Inspector Sughra Nazir Unannounced Inspection 22 November 2005 10:45 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 View DS0000033613.V268286.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holme View Address Gillingham Green Holme Wood Bradford BD4 9DT 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) 01274 681682 01274 687205 City of Bradford Metropolitan District Council Department of Social Services Mr John Venner Care Home 37 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (37), Old age, not falling within any other of places category (37) Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: Holme View is operated by Bradford Metropolitan District Council and provides residential care and day care. The home is still in the transitional period as the service user category is changing from elderly to a dementia home. The home is currently providing a dual service with the ground floor occupied by people who were already resident in the home with existing staff. Staff and service users from the dementia unit transferred to the site and now occupy the top floor. The home is continuing to operate as two separate units. Holme View is a purpose built establishment located in the Holmewood area on the outskirts of Bradford city centre. It is convenient to local amenities and services. The home is designed with four separate wings. Digital locks are fitted around the home and on all exit routes making sure that service users are safe. There is also a day centre on the premises. Day care is not regulated and therefore is not inspected. Although the home is close to the city centre it has a green outlook a secure fence surrounds the perimeter and there is a garden where service users can sit out.. It has a good working relationship with the local health centre from which District Nurses attend the home on a weekly basis giving advice and support to the staff. All laundry is dealt with on the premises. There are adequate numbers of bathrooms and toilets and a new walk in shower has been fitted. All meals are prepared in the main kitchen but service users have their meals in the dining rooms on each wing; the meals being distributed using a hot trolley. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections; these may be announced or unannounced. The last inspection took place in June 2005. There have been no further visits until this unannounced inspection. This inspection started at 10.45am and ended at 4.00pm, in addition to the time spent in the home, Time was spent preparing for this inspection. During the inspection, records were looked at and some areas of the home seen, such as bedrooms, lounges, dining rooms, toilets and bathrooms. Care staff were seen carrying out their work and members of the management team and staff were spoken with. Due to their level of dementia, many service users on the top floor were unable understand the purpose of the inspection, however their body language was observed and their interaction with staff and other service users. Comment cards/questionnaires are left for service users, visitors and other professionals at each inspection, thereby giving the opportunity for anonymous feedback. Eight comment cards were received back from service users and six comment cards from relatives/visitors were also considered as part of this inspection. Five out of the 8 service users commented that they liked the food sometimes. Six service users said they would like to become more involved in decision-making within the home. Four service users commented that the home did not provide suitable activities and one service user said that suitable activities were provided “sometimes”. 2 service users said that they did not know who to speak to if they were unhappy with their care. The comment cards received from visitors were all positive about being made welcome, being able to visit their relative /friend in private and being kept informed about important matters affecting their relative/friend. One comment made by a relative was “ The standard of care given to my mother is excellent”. One relative commented they were unaware of the home’s complaints procedure. Four relatives said that they were not made aware of forthcoming inspections and did not have access to copies of the inspection reports on the home. What the service does well: The home makes very good use of assessment tools to inform care planning. The environment in the home is improving. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 6 There is a snack and gift shop for service users for the purchase of toiletries, confectionary and cards etc. This helps service users choose products for themselves and keep in touch with family and friends. Staff have access to a variety of training courses and are proactive about making their training needs known. 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. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Service users benefit from care plans that are detailed. Not all information about service users care is held confidentially. EVIDENCE: Care plans are generated from comprehensive assessments and making good use of tools such as Barthel scoring. Falls risk assessments and risk assessments for moving and handling were in place on the files inspected. The acting manager has carried out an audit of care plans and has identified any omissions/areas to be addressed. The reviewing of care plans in this way is good practice and should continue. This audit identified that some reviews of care plans are outstanding and signed consent forms for nightly checks are required for some service users. Three service user care plans were reviewed for each floor. One care plan did not have any evidence of the involvement of the service user or their relative in compiling the plan. One service user’s religious needs were recorded as Methodist but there was no further information about how this affected their care. The assessment Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 10 stated that they had water retention but there was no accompanying care plan relating to monitoring the condition, fluid intake , promoting activity etc. Another file stated that the service user benefits from having a soft diet. The cook confirmed that no service users receive a soft meal. There was a note to state that medication was discontinued by the GP – this note was undated. Service user files provided evidence of appropriate involvement of GPs, and referrals to specialist services. The files also contained evidence of forms completed for help with prescription costs and confirmation of registration on electoral register. Medication administration records for 12 November 2005 , 13 November 2005 and 19th November 2005 were incomplete. All omissions were brought to the attention of the manager on duty. The home must ensure that all records are completed using the codes on the sheets. A Nomad cassette box had an entry tippexed out which is unsafe practice. Some notices were displayed on a notice board in Elm dining room entitled personal care monitoring sheets that provided a record of when bath, nails and other personal care tasks had been provided for individual service users. Separate notices also listed when care plan documentation needed to be reviewed. Whilst it may be helpful to have aide memoirs, this information should either be placed in service user files or displayed in staff areas so that individual privacy and confidentiality is not compromised. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Activities for service users with dementia are limited. The environment in which food is served and the timing of meals requires improvement. EVIDENCE: A programme of activities and entertainment is in place. However, further work is needed to meet the needs of service users with dementia. Currently activities generally take place downstairs and a small number of service users are accompanied downstairs for them to participate. No activities are planned for those not able to participate due to dementia. Some thought could be given to replicating or extending the activities of the onsite dementia day care centre to meet this need. Staff mentioned that service users are encouraged to retain skills and have been encouraged to be involved by folding linen, performing light dusting or baking. This is good practice. Lunch was observed in two dining rooms. Service users were offered a choice of hot and cold drinks with their meals. No menu was displayed. On Elm the dining room was very hot – service users partly shaded by blinds fitted to the windows. The inspector adjusted the blind to increase the shade Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 12 and comfort to one service user. Staff said that portable fans had been used but posed a risk. Their suggestion of a ceiling fan would alleviate the problem The meal for the day was chicken and vegetables followed by trifle. Staff offered to cut up food and engaged service users in conversation throughout the meal. In the dining room serving the day centre trifle was served to some service users on tea plates making it difficult to eat. Staff said that a light supper of sandwiches was served at 8pm at the latest. Breakfast is prepared in the central kitchen and both the chef and staff on Elm stated that porridge was brought up at 9am. There is a risk that there is a gap of more than 12 hours between these meals. This should be addressed. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 13 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, 17 and 18 Service users are protected from abuse by staff who know about their responsibilities. EVIDENCE: Information about how to complain is contained in the service user guide and is displayed on notices on each unit. This is good practice. However, these notices require some amendments. The name of the departmental complaints officer, their telephone number and the number for the Commission were noted to be incorrect. The notices could be improved further by making use of larger fonts and/or pictures to ensure accessibility The organisation has guidance and procedures in place on appointeeship and such matters are handled separately by a central administration team. This helps to protect the rights of service users. Service user files showed that registrations on the electoral roll have been maintained. A record of complaints and compliments about the service is maintained and letters inspected showed timely and appropriate responses take place. All staff have had training on Adult protection and in conversation confirmed that they were aware of their responsibilities to report suspected abuse. From information provided to the home about specific incidents, it is clear that the home seeks advice from the local adult protection unit and takes necessary steps to protect service users. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Service users live in a clean environment with facilities in place to meet their needs. Infection control practice is not followed in all cases and this could place service users at risk of infection. EVIDENCE: Most areas of the building were inspected including communal lounges and a number of bedrooms. A snack shop is provided on the ground floor and service users can purchase other items such as cards and gifts that assist them in maintaining links with family and friends. This is good practice There is a separate lounge available for service users who smoke. On Willow photographs of bygone Bradford were displayed in corridors this is good practice. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 15 Bedrooms show varying degrees of personalisation and some bedroom doors have service users photographs on them to aid orientation. This is good practice and should be promoted further. On Ash unit the bathroom door lock is missing and requires replacing to ensure privacy for service users. A wheelchair foot rest was seen in the lounge on this unit and should be removed for safety. The door of bedroom 29 is difficult to open and requires adjustment. Aid and adaptations for independent use of toilets were seen in place. In the newly established assisted bathroom a bar of hand soap and towel belonging to a service user were seen– such items should be removed in the interest of infection control. A disposable hand towel facility and soap dispenser should be fitted. The home recently experienced an infectious outbreak and received advice from local Environmental Health services. Whilst most of the recommendations have been actioned a small number remain outstanding these include ; • • • ensuring all staff know correct procedures for handwashing following illustrated signs ensuring mops etc are colour coded and that cleaning solutions are mixed to manufacturer’s instructions. handwashing and paper towel facilities to be available in bedrooms for staff. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 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 Staffing levels at night are low for service users with dementia who are awake and could be at risk. EVIDENCE: Staff said that a significant number of service users on the dementia wings are awake during the night. The home currently has 2 members of staff on duty and access to one member of staff asleep on site. This is not sufficient for the dependency levels. A review of staffing is underway and there was some concern expressed by staff that the review would not take account of the specific needs of the dementia units. Staffing files were not available for inspection. Staff training notices were seen offering training to all staff on diabetes, blood sugar monitoring, MRSA, Food Hygiene awareness, dementia and First Aid. Staff confirmed that access to training was very good. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 17 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): 32, 35, 37, and 38 The home’s management arrangements have been disrupted and service users meetings have not been maintained. It is essential that systems are put in place to make sure there is clear leadership to staff, which provides comprehensive guidance on the ethos and culture of the home. EVIDENCE: The home is still in transition and from conversations with staff it was evident that not all staff had accepted the changes as permanent. They acknowledged the manager’s efforts. Some staff are covering shifts in the . The registered manager is temporary absence from the home and there is an acting manager in post. The home carries out an annual survey and outcomes are reported in a newsletter. The newsletter also keeps service users and relatives updated on Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 18 developments within the home. A staff questionnaire provides staff with the opportunity to have their say. This is good practice. Service users meetings have not taken place for some time and this practice should be reinstated. The comment cards received from service users contained several requests to be more involved in decision-making within the home. Due to the manager’s absence from the home a number of records were not available for inspection. The service must ensure that all records required for the efficient management and administration of the home are available for the person acting as manager and for inspection. Staff records could no be inspected. Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 19 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 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X X X X 2 3 Holme View DS0000033613.V268286.R02.S.doc Version 5.0 Page 20 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 Requirement All needs identified by assessment must be specified in care plans. Monthly reviews and nutritional screening must be documented. Service users or their relatives must be involved in care planning. The home must ensure that all medication administration records are completed in accordance with Royal Pharmacautical Society guidelines. Notes relating to medication discontinued must be dated. Information about service user’s personal care routines (personal care monitoring sheets) and reviews etc must be stored confidentially. Service users interests must be recorded and opportunities provided for stimulation through leisure and recreational activities that meet the needs abilities and preferences of service users. Particular attention must be paid to the needs of service users DS0000033613.V268286.R02.S.doc Timescale for action 31/03/06 2 OP9 13 17 (1) (a) 28/02/06 3 OP10 12 (4)(a) 28/02/06 4 OP12 14(1(a) 4(1)(a) 30/04/06 Holme View Version 5.0 Page 21 5 OP15 12(2) (3) with dementia. Up-to-date information about activities must be circulated to all service users in formats suited to their capabilities Identified needs for a soft diet must be implemented. Appropriate crockery must be made available in all dining rooms. Attention must be paid to ensure that the physical environment for dining is comfortable. 31/03/06 6 OP16 22 (1)-(6) 7 OP19 23 8 OP26 13 (3) 9 OP27 19 10 OP32 19 11 OP37 17 The displayed information on how to complain must be corrected and made available to service users in an accessible format. Repairs to doors and locks identified and discussed during the inspection must be carried out. A paper towel dispenser and soap dispenser must be provided in the assisted shower room. Advice on colour-coding of cleaning materials and dilution of cleaning agents as well as all other Enviromental Health recommendations must be fully implemented. Nighttime staffing levels must reflect the high dependency levels of service users particularly those with dementia who are awake for significant periods during the night. Service user meetings must be re-introduced to give service users opportunity to become more involved in decisionmaking in the home. Records must be made available to the person acting as manager and must be available for DS0000033613.V268286.R02.S.doc 28/02/06 28/02/06 28/02/06 31/03/06 31/03/06 31/03/06 Holme View Version 5.0 Page 22 inspection. 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 View DS0000033613.V268286.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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