Inspection on 12/07/10 for Holmer Care Centre

This inspection was carried out on 12th July 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmer Care Centre 22/09/10

Holmer Care Centre 17/09/10

Holmer Care Centre 17/08/10

Holmer Care Centre 20/07/10

Holmer Care Centre 08/01/08

Holmer Care Centre 21/02/07

Holmer Care Centre 10/02/06

Holmer Care Centre 05/10/05

Holmer Care Centre 26/01/05

Holmer Care Centre 06/07/04

Holmer Care Centre 02/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Random inspection report Care homes for older people Name: Address: Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Blake Date: 1 2 0 7 2 0 1 0 Information about the care home Name of care home: Address: Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG 08453455745 01432342390 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs S Roberts,Mr Jeremy Peter Ewens Walsh Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 49 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 49 49 The maximum number of service users who can be accommodated is: 49 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 49, Mental disorder, excluding learning disability or dementia (MD) 49 Date of last inspection Care Homes for Older People Page 2 of 15 Brief description of the care home 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 Homes Statement of Purpose and Service User guide. There is information literature describing the service displayed at the home and copies are available on the Providers website address. New residents receive a copy of this information and it also forms part of staff induction packs. Details of fees and additional charges are available from the Providers website address. A copy of this report can be viewed at the home. Care Homes for Older People Page 3 of 15 What we found: We visited Holmer Care Centre because Herefordshire Council had made us aware of some serious concerns about the home. One inspector carried out an unannounced inspection over one day. We spent time observing how people who live at the home are looked after, and we looked at records of the care provided. We spoke to people who live at Holmer Care Centre, and visitors to the home. The home has employed a new manager, and the Operations Manager for Blanchworth Care was at the home to support her, as she had only been working at the home for three days. We found some areas of serious concern, and we have referred these to Herefordshire Council, under its procedures for safeguarding vulnerable adults. The people who live at Holmer Care Centre are particularly vulnerable, as they all have dementia, and many of them are not able to communicate verbally. We have grouped our evidence under headings, to make it easier for people to find relevant information. DEMENTIA CARE Holmer Care Centre specialises in caring for people with dementia. As such, the home should be providing person-centred care. The Alzheimers Society explains how personcentred care works: Instead of treating the person as a collection of symptoms and behaviours to be controlled, person-centred care considers the whole person, taking into account each individuals unique qualities, abilities, interests, preferences and needs. Although everyone who lives at Holmer Care Centre has a detailed care plan, the care plans are broken down into activities of daily living, rather than giving a picture of the whole person. The home uses charts with tick boxes to record the care that staff have provided for people, such as bathing or taking people to the toilet. These tick boxes do not promote person-centred care, as they reduce the person to a series of tasks to be completed. One of the most effective ways to promote person-centred care is to ensure that staff are trained in dementia care, so that they have the skills and knowledge to provide care which meets peoples individual needs. Records showed that eighteen of the staff who care for people living at the home have not had training in dementia care. People with dementia benefit from an environment which is rich in sensory stimulation. This could include music, rummage boxes, memorabilia from the past, magazines, and textured fabrics, for example. Unfortunately Holmer Care Centre provides an environment which is almost totally devoid of any sensory stimulation. In each lounge, armchairs were ranged around the edges of the room, meaning that it would be very difficult for people to socialise. The lounges were very sparsely furnished, and there were no magazines or books for people to look at. We looked in a cupboard in one of the upstairs lounges, and we found two newspapers which were over six months old and a dried up piece of food debris. We were told that all the equipment used by the activities co-ordinator is kept Care Homes for Older People Page 4 of 15 locked away. During the day, we saw people aimlessly walking around the home, or sitting in the lounges with nothing to occupy them. We did not see a single person engaged in any meaningful activity. Staff were kind and caring when they talked to people, but did not have time to provide anything other than care which met peoples physical needs. MEDICATION We wanted to see if the home manages medication safely. Nobody who lives at Holmer Care Centre is able to take responsibility for their own medication, so it is very important that people can trust the staff to manage this for them. When we asked to look inside the medication trolley, the nurse fetched the keys to the trolley and medication storage cupboards from an unlocked drawer in the staff room. It is essential that keys for medication storage are kept securely on the person of the staff member who is responsible for medication. We saw that one person had refused to take all their medication for over a week. This had been recorded on the persons Medication Administration Record (MAR) sheet, but no action had been taken to ensure that the person was not at risk by not having their medication as prescribed. The person had been prescribed medication to lower their blood pressure, and other medication to prevent a cancer from progressing. The fact that this medication had not been given for over a week placed the person at high risk of harm. We asked the home to contact the persons GP as a matter of urgency. We saw that two other peoples medication was not in stock at the home, and therefore they had not been given their medication for a week. The home should have procedures in place to ensure that medication is in stock, so that people can receive their medication as prescribed. Some people who live at the home take some medication as and when they need it. We found that there were not always written instructions for staff to tell them when to give this medication. For example, one person sometimes needs medication when they become agitated. There was no information for staff to tell them at what level of agitation the person would need to take the medication. We checked to see if the home was keeping accurate records of medication. We looked at the records for one person who had been prescribed paracetamol 500mg to be taken as required. The MAR sheet showed that the person had been given paracetamol on five occasions, and that there should have been 90 tablets left in the box. When we counted the tablets, we found that there were actually only 82 left in the box. This means that the records kept by the home were not accurate. We checked staff training records, and these showed that only one of the staff who were administering medication had received recent training to make sure that they had the knowledge and skills to do so safely. BEHAVIOUR Some people who live at Holmer Court sometimes behave in a way which could place Care Homes for Older People Page 5 of 15 themselves or others at risk of harm or injury. We saw that one person had been described in their care plan as very angry and resistive to interventions. There was no further information to tell staff how they might support the person so that they did not react in this way. We would expect to see a plan which clearly states how staff can prevent the person becoming upset, and ways to calm the person down. EATING AND DRINKING People were very positive about the food at the home. One relative described it as exceptional. We saw that people were enjoying their lunch and that staff were supporting people who needed assistance in a sensitive and discreet manner. We were concerned to see that there were no drinks available in any of the lounges other than at designated times. The weather had been very hot, and there is a real risk of dehydration if people do not have access to drinks. The new manager has assured us that drinks will be provided in all the lounges so that people can help themselves whenever they are thirsty. PROTECTION Records showed that staff had noticed that one person had an unexplained injury. Staff had correctly completed an incident form and had recorded the details in the care plan. However, the information had not been passed on to anyone in a management position, and the persons GP had not been informed. We have referred this to Herefordshire Council under its procedures for safeguarding vulnerable adults. We also asked the home to contact the persons GP. Herefordshire Council had made us aware of incidents which should have been reported to them under the Councils procedures for the safeguarding of vulnerable adults. The home had not made the necessary referrals. The accident records showed that one person had had a series of falls, which appeared to have been caused by staff failing to apply the brakes on the persons bed correctly. The risk assessment had not been updated, and there was no information in the risk assessment about the bed brakes. We looked in the persons bedroom, and saw that there was no call bell. There was no information to tell staff how the person could call for help if they needed it. It is not acceptable that a person should continue to fall when there are measures which should be in place to manage the risk. ENVIRONMENT Generally the home is dirty and is not kept clean and hygienic. We looked in a bedroom which was empty and had been cleaned ready for a new occupant. The mattress was stained with brown marks. A commode stored in the ensuite toilet was visibly dirty and stained. Some walls were marked with what appeared to be dried on food stains. We saw that there was an open waste bin in the upstairs lobby. The bin contained discarded gloves and aprons and a soiled tissue. We saw that a person who lives at the home was Care Homes for Older People Page 6 of 15 rummaging in the bin. People with dementia benefit from an environment which gives them visual cues, so that they can find their way around the home, and are easily able to identify important rooms such as the toilet. At Holmer Care Centre, the corridors are all painted in a neutral colour and the toilet and bathroom doors are only identified by a small label. STAFFING We observed staff during the inspection. They were kind and caring in the way they supported people, and were careful not to hurry them. However, the staff seemed extremely busy and at times it was difficult to know how people would be able to get help if they needed it. We heard someone calling for help from one of the bedrooms. The new manager unlocked the bedroom door and went in. The person was very distressed and their call bell was not within their reach. The new manager rang the call bell, and after about four minutes a staff member arrived, but told us that she was the only staff member on the upper floor, as other staff had gone to cover downstairs while staff had their tea breaks. We saw that a nurse had taken over two hours to complete a medication round. She told us that this was because the home was short staffed, and therefore she kept being interrupted to help with care tasks. A relative told us that, a few days previously, there had been no staff available to serve tea upstairs, and the tea trolley had been taken back downstairs without anyone having been given their drinks. On the day of the inspection, the tea trolley was left in the upstairs lobby for over fifteen minutes, before we intervened to ask the new manager to make sure that people were given their drinks. The new manager told us that staffing levels are set at the head office of Blanchworth Care, and that rotas are sent to the home. The Operations Manager told us that rotas are worked out using information from the home about peoples needs. It is apparent that this system is not effective, and can lead to the home being short staffed. We have already described that staff who administer medication have not had the required training. Records showed that only four staff have First Aid training. This included the new manager, who had only been working at the home for three days. This means that there have been occasions when there has been no member of staff on duty who is trained in First Aid. This puts people at risk if there is a medical emergency. MANAGEMENT The home has been without a manager since the end of April. In the interim, there have been alternative management arrangements made by the provider until a new manager could be appointed. During the day, we saw evidence that the home is suffering from a lack of leadership and direction. The provider has not put adequate support systems in place while there has been no manager, and this has put people who live at the home at very high risk of poor outcomes. Care Homes for Older People Page 7 of 15 Herefordshire Council had made us aware of incidents within the home which should have been notified to us. We checked our records and the home had not notified us of these incidents. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) You must ensure that, where peoples behaviour could pose a risk to themselves or others, there is a written plan in place to tell staff how to manage the behaviour. This is so that peoples needs can be met. 10/08/2010 2 8 13 (4) You must ensure that falls risk assessments are reviewed in cases where the person has experienced a fall since the risk was previously considered. This will assist the home in reviewing whether there is any further preventative action they can take following each fall. 10/08/2010 3 8 16 (2) (i) You must ensure that 10/08/2010 people have access to sufficient supplies of fluids at all times. This so that people are not at Care Homes for Older People Page 10 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action risk of dehydration. 4 8 12 (1) You must ensure that the 10/08/2010 numbers of staff are appropriate to the assessed needs of people living at the home, taking into account their individual health and personal care needs, at all times. This is so that people can be confident that their needs will be met in a timely manner, and to ensure that they are not at risk of their needs not being met. 5 8 13 (1)(b) You must put an 10/08/2010 effective system in place to ensure that concerns about peoples health and well being are referred to health care professionals in a timely manner. This is so that people can be confident that their health needs will be met. 6 9 13 (2) You must put an effective 10/08/2010 system in place to ensure that medication records are accurately maintained. This is so that people can be confident that medication is managed safely. 7 9 13 (2) You must ensure that, for 10/08/2010 any medication labelled for use when required, as directed or with a variable dose, there is always clear written direction for staff on Page 11 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This will help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 8 9 13 (2) You must make 10/08/2010 arrangements to ensure that all medication is administered as directed by the prescriber. This is so that people can be confident that they will receive their medication as prescribed. 9 9 13 (2) You must ensure that 10/08/2010 arrangements are in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is so that people can be confident that medication is managed safely. 10 9 12 (1) You must ensure that 10/08/2010 prescribed medication is in stock for all persons living at the home. This is so that people receive their medication as prescribed. Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 11 12 16 (2)(n) You must ensure that people have access to recreational activities and facilities which meet their individual needs. This is so that people are able to occupy themselves as they wish. 10/08/2010 12 18 13 (6) You must ensure that effective systems are in place to ensure that appropriate referrals are made of any suspected abuse or neglect, as laid down in the Herefordshire Multi-Agency Policy and Procedures for The Protection of Vulnerable Adults from Abuse. This is so that people are not at risk of neglect or abuse. 10/08/2010 13 26 13 (3) You must put an effective 10/08/2010 system in place to ensure that the home is kept clean and hygienic. This is so that people are not at risk of infection. 14 27 18 (1)(a) You must ensure that staff are suitably qualified, experienced and competent to safely administer medication, before they administer medication to people in the service. This is in order to ensure that people who live in the service are protected from 10/08/2010 Care Homes for Older People Page 13 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action harm. 15 38 37 You must put an effective 10/08/2010 system in place to ensure that the Commission is notified in writing of any incidents that may affect the wellbeing or safety of people who use the service. This is to ensure that peoples wellbeing and safety are promoted. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 You should ensure that care is planned and provided using a person-centred approach. This is so that people receive care that meets their individual needs. You should ensure that the environment provides visual cues for people with dementia, so that they can easily find their way around the home. 2 19 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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