This inspection was carried out on 10th February 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.
CARE HOMES FOR OLDER PEOPLE
Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG Lead Inspector
Sandra J Bromige Unannounced Inspection 10th February 2006 11:45 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 Holmer Care Centre DS0000027681.V282999.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. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holmer Care Centre Address Leominster Road Hereford Herefordshire HR4 9RG 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) 08453 455745 01432 342390 Mrs S Roberts Mr Jeremy Peter Ewens Walsh Mrs Susan Marshall Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (49), Old age, not falling within any other category (49) Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1. Two named service users with dementia under the age of 65. Date of last inspection 5th October 2005 Brief Description of the Service: Holmer Care Centre is on the outskirts of the city of Hereford. It is owned and managed by The Holmer Partnership, Blanchworth Care. The Home was first opened in December 1991. It is a Victorian property that has been extended to provide a Care Home with nursing for a maximum of 49 older persons over the age of 65 years, of both sexes, who have dementia or a mental disorder. Twenty nine bedrooms are single occupancy, eighteen have en-suite facilities. The Home has a passenger lift. The Home operates a ‘locked door’ policy, as indicated in the Home’s Statement of Purpose and Service User guide. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 11.45 – 15.00 hrs on Friday 10th February 2006. Time was spent walking around the Home, talking to residents, staff & visitors, observing staff practice and the lunchtime meal, and inspecting records. As people with dementia are often unable to tell the inspector how they are faring, the Inspector also spent time observed residents for signs of well or ill-being. Comment cards were sent to the Home in July 2005 for distribution to the residents and relatives. None have been received back from residents and only 3 from relatives. These are too few to be able to draw any general conclusions from this exercise. One of the comment cards raised a concern about aspects of the care of this person living at the Home. This complaint was referred to the manager to investigate. What the service does well: What has improved since the last inspection?
The residents care needs are being reviewed and recorded each month and more often as the need is identified. The extension to the Home providing an additional 14 single en-suite bedrooms was completed in December 2005. The new bedrooms are bright, and well furnished. The new dayroom is light, well furnished and provides
Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 6 direct access into a secure garden area where residents can walk about freely or just sit outside on the garden furniture provided. Additional assisted bathing facilities have been provided with the new extension. The existing building has also been partially upgraded and re-decorated including new corridor carpets. The laundry has been re-sited into a much larger and more appropriate area of the Home. The hairdressing room has also been re-sited in the Home with improved facilities. Shower facilities have also been provided for staff in the Home. 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. Holmer Care Centre DS0000027681.V282999.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 Holmer Care Centre DS0000027681.V282999.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): None of these standards were assessed during this visit. EVIDENCE: Holmer Care Centre DS0000027681.V282999.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&9 Systems are in place for identifying, planning, recording and evaluating the individual residents care needs. Identified current practice for the administration of medicines is not safe and has the potential to put residents at risk of being given the wrong medication. EVIDENCE: Two residents care records were seen on this occasion. Both of these residents have lived at the Home for over 3 years. The care plans gave detailed information about the identified care needs of the residents. The care plans and risk assessments are being reviewed each month or more often if identified as being required. Wound care plans are in place with good photographic information and action plans for care. There is a key worker system in place in the Home, although it is evident from the list supplied by the organisation that not all of the current residents have an allocated key worker. A recent incident has been reported to the Commission about inaccurate administration of medicine to an identified resident. The Commission are awaiting further information from the Home regarding this incident. During this visit a trained nurse was observed to enter a residents room in the new
Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 10 wing with medication and no Medication Administration Record to recheck the medication prior to giving this to the resident. The trolley from where the medicine was put out was secure but was located outside the sitting room in the old part of the building. This is a considerable distance from the room in the new extension. This practice and its safety were discussed with the manager particularly in light of the recent incident and a prior medicine incident at the end of October 2005. Written procedural guidance provided by the pharmacy inspector was given to the manager. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 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): 15 Serving arrangements need improving to ensure that hot desserts remain hot until they are ready to be eaten by the residents. EVIDENCE: Residents were observed eating lunch in all of the dining areas of the Home. One resident was having lunch with his wife in the new sitting room. Residents indicated that they enjoyed the lunch. Two residents were seen enjoying a glass of beer with their lunch. Staff were observed assisting residents to eat in the dining room and the privacy of their bedrooms. This was being carried out in a discreet and sensitive manner and the staff were chatting to the residents making it a social occasion. The nursing and care staff on each floor serve the food. The main course is portioned for each resident by the chef prior to leaving the kitchen. The staff serve the dessert. On the day of the inspection it was a hot pudding. On one floor the container of pudding was stood on the table in the corridor for the duration of time that it took to serve the lunch. There was no means of keeping the dessert hot. Residents eating in their rooms were taken their main and dessert courses at the same time. This is not good practice. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this visit. EVIDENCE: Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 & 26 All hot pipes in the Home accessible to residents were not covered to protect residents from being burnt. Procedures for the disinfection and air-drying of commode pots need reviewing to ensure that they do not remain wet allowing bacterial organisms to grow. EVIDENCE: An identified bedroom had exposed hot pipes that were at floor level and were not covered. The Home was clean and tidy and free from any bad smells with the exception of an identified corridor. Hand washing facilities are in place. Protective gloves and aprons are provided for staff to prevent cross infection. Mechanical sluice machines are provided for disinfecting commode pots and urinals. Wet commode pots were observed in 2 sluices stacked together. This is not good practice for the management of infection. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing levels are not sufficient at all times to meet the needs of the residents. EVIDENCE: On the day of the inspection the numbers of staff provided for 44 residents were good. On the day of the inspection the manager was one of the registered nurses on duty in the Home. The manager confirmed that the day before the staffing levels were 2 registered nurses and 6 care staff in the morning and 2 registered nurses and 6 care staff until 4pm and 5 care staff until 7pm for 43 residents. This is not satisfactory. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 The current office facilities in use do not provide the manager with adequate space and privacy to enable her to carry out her duties efficiently and effectively. Practices in the Home are not promoting and protecting the health & safety of the people living in the Home. EVIDENCE: The manager’s office is currently used by all of the trained staff and is also the room where medication, 2 medication trolleys and dressings are stored. It was required as part of the extension to the Home that a separate manager’s office is provided. A room on the ground floor had been decorated for the manager to move into at the point of registration of the new extension. On the day of the inspection the room was not being used as the manager’s office. The room was stacked floor to ceiling with boxes of pads. It is evident from discussion with a relative that this room is also being used as a private dining room on occasions. With the increased numbers of residents and staff in the Home it is not satisfactory for the manager to continue to use the congested room upstairs as her office.
Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 16 The Home has recently had an Environmental Health inspection. The inspection identified some minor issues that needed to be addressed and the need to review the provision of fridge and freezer space with the increased numbers. The manager confirmed that a larger fridge has now been purchased by the Home. Currently one of the hoists for moving residents is out of use. A number of bedroom doors were wedged open with commodes. This is not good practice as in the event of fire it places residents at risk. Exposed hot water pipes were found in an identified room. The manager was advised immediately of this finding. Prior to registration of the new extension, the Commission required the Home to address identified areas where hot pipes were exposed. This was done and the organisation also agreed to undertake a review of all hot pipes in the home with regard to securing the lagging or to boxing them in. The laundry room door was being held open with a chair; the manager addressed this at the time of the inspection. Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X 2 3 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 3 X X X X X X 2 Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement When medicines are transported around the home it must be done so in a secure manner and whichever method of transporting the medicines is used care must be taken that they can be quickly and securely locked away in the event of an emergency Serving and feeding arrangements must be managed to ensure food remains hot. The hot pipes must be covered at all times to prevent any injury to the resident. An immediate requirement notice was issued. Commode pots must be disinfected, air-dried after use and stored singularly upside down when not in use. Doors to residents’ bedrooms must not be wedged open with furniture. The registered person must carry out a review of all hot pipes in the home to ensure that residents are not at risk of being burnt. A copy of this review and
DS0000027681.V282999.R01.S.doc Timescale for action 28/02/06 2 3 OP15 OP25 12, 16 13 28/02/06 10/02/06 4 OP26 13 28/02/06 5 6 OP38 OP38 13 13 28/02/06 28/02/06 Holmer Care Centre Version 5.1 Page 19 any action plan must be submitted to the Commission. 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 Holmer Care Centre DS0000027681.V282999.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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