Inspection on 17/09/10 for Holmer Care Centre

This inspection was carried out on 17th September 2010.

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

Holmer Care Centre 22/09/10

Holmer Care Centre 17/08/10

Holmer Care Centre 20/07/10

Holmer Care Centre 12/07/10

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 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 7 0 9 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 2 0 0 7 2 0 1 0 Care Homes for Older People Page 2 of 11 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 11 What we found: We stopped awarding quality (star) ratings under the Care Standards Act 2000 on 30 June 2010. No new ratings have been awarded since that date. This report should be read in conjunction with other reports of recent inspections of Holmer Care Centre. We visited the home to see if they had complied with two Statutory Requirement Notices which had been served on the providers, Mrs Sally Roberts and Mr Jeremy Walsh. These were in respect of general health and welfare issues, and infection control. We had found serious shortfalls in both of these at our last inspection. Two inspectors spent over half a day at the home. We spoke to people living at the home and their relatives, we checked care records and we observed staff carrying out their duties. We also spoke with the interim manager and one of the providers, and we checked the home for cleanliness and infection control. 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. PRESSURE AREA CARE Many of the people who live at Holmer Care Centre are not able to walk or move without help. This means that they are more likely to develop pressure sores. Therefore it is very important that the home takes the necessary action to ensure that pressure areas are cared for appropriately. At the last inspection, we had raised concerns about the way in which the home was managing pressure area care. Therefore we checked the records for a person who had been assessed as being at high risk of developing pressure sores. Records showed that the person had recently developed a pressure sore. The care plan stated ensure he sits on a pressure-relieving cushion. We saw the person sitting in the lounge during the morning and the afternoon, and we saw that he was not sitting on a pressure-relieving cushion. We were so concerned for this persons welfare that we have referred this to Herefordshire Council, under its procedures for safeguarding vulnerable adults. MOBILITY At our last inspection we had observed unsafe moving and handling practices, which put people at risk of harm or injury. We therefore spent time observing staff as they assisted people to mobilise. We were very concerned to see staff continuing to use unsafe practices. We saw one Care Homes for Older People Page 4 of 11 person being transferred using a hoist. The sling was not applied correctly and appeared to be too large for the person. As the hoist was raised, the person was seen to be in imminent danger of falling out of the sling. We immediately intervened and asked staff to lower the hoist. We checked the persons care plan. This stated that the moving and handling assessment had been carried out by one of the nurses at the home. The manager told us that she did not believe that this nurse was qualified to carry out this assessment. Moving and handling is a specialist area and staff require the appropriate training to ensure that it is carried out safely. The persons moving and handling assessment identified the equipment needed as Oxford full hoist, medium sling. This sling was too large for the person, as records showed that the persons weight was considerably lower than the minimum weight specified by the manufacturer. We saw staff using a stand aid hoist to assist people. A stand aid hoist relies on the person being hoisted being able to follow simple instructions. We saw that one person had difficulty placing their feet on the footplate and then let go of the hand holds on the stand aid hoist during the manoeuvre, and this put the person at risk of falling. The persons care plan stated assess ability each time before mobilising to establish if a sling hoist or stand hoist will be used. We did not see any assessment of the persons ability being carried out by staff before they used the stand aid. We saw other examples of poor moving and handling practice, such as the use of underarm drags, which put people at risk of shoulder injuries. These issues are serious and pose a significant risk to people who need assistance with their mobility. We have referred this to Herefordshire Council, under its procedures for safeguarding vulnerable adults. DIABETES MANAGEMENT Records showed that some people who live at the home have diabetes. This places them at increased risk of many health complications. Therefore it is extremely important that diabetes is managed safely. We checked the care plan of one person with diabetes. This person needs insulin to make sure their blood sugar levels are kept within safe limits. Records showed that the persons blood sugar is checked daily. The care plan stated if her BM is low, give her something sweet (BM refers to blood glucose levels). There was no information in the care plan to show what would be considered a low blood glucose measurement for that particular person, and no information about how much glucose should be given. Diabetes UK states that low blood sugar should be treated immediately with 10-20g of a short-acting carbohydrate such as: a glass of Lucozade or non-diet drink; three or more glucose tablets; five sweets e.g. jelly babies or a glass of fruit juice. We saw that staff had been treating low blood sugar levels inconsistently. We asked the Lead Nurse to explain when she would give glucose. She said that she would give it if the blood glucose level was below 4.0 mmol. The records showed that one member of staff had given milk with glucose when the blood glucose level had been measured at 4.7 mmol, and another had given a milky drink when the blood glucose level had been measured at 6.2 mmol. Records showed that staff had not been recording the amount of glucose given. Examples of entries in the records included sweet drink given, fruit drink given and milky drink given. These entries do not give enough information about the amount of glucose given. Care Homes for Older People Page 5 of 11 We have serious concerns about the management of diabetes at Holmer Care Centre, and we have referred this to Herefordshire Council, under its procedures for safeguarding vulnerable adults. All the above concerns show that the home has failed to comply with one of the Statutory Requirement Notices served on the providers. We have made two immediate requirements, which the home must comply with within 48 hours, because we are so concerned about the risk to people living at the home. We will be working with our legal advisers to decide how to proceed. In the meantime, we have shared our concerns with the Local Authority and the Primary Care Trust, and they are monitoring the home on a daily basis. We will continue to work closely with other agencies, so that we can ensure that people are not at risk of harm. INFECTION CONTROL Our previous inspections had raised concerns about how infection control was being managed within the home. We were pleased to see that there had been many improvements in this area. The home was no longer odorous, and we saw that bathrooms and toilets were kept clean throughout the day. We saw that furniture and soft furnishings were being regularly checked, and being removed for cleaning where necessary. There were appropriate places for staff to dispose of waste and we saw that staff were using personal protective equipment, such as gloves and aprons, whenever they carried out personal care tasks. We were disappointed to find that there were still some areas of concern. We looked inside a rummage box in one of the lounges. Rummage boxes should contain interesting objects for people with dementia to enjoy using. This particular rummage box contained, among other items, a paper napkin stained with a brown residue; a partially eaten mouldy banana; a burst balloon with unidentified dried liquid on it; a dirty and sticky handbag, and several torn old magazines and newspapers. Aside from the unhygienic nature of these items, the fact that this box was available for people living at the home shows a worrying lack of respect. We have taken a proportionate view of the homes response to the Statutory Requirement Notice about infection control, and we therefore consider that they have complied with the Notice. MANAGEMENT We continue to have concerns about the management of the home. The fact that there has been so little progress on areas of high risk indicates that the home is not being run in the best interests of the people who live there. There is still no permanent manager in post, and the interim manager is being supported by one of the providers, Sally Roberts, and other members of the Blanchworth management team. There has been poor communication on occasions. For example, the interim manager was unaware that one person had a pressure sore, and that another person needed to have their leg elevated. Care Homes for Older People Page 6 of 11 In a home where there is such a high level of risk, it is extremely important that management is consistent and effective. We have not found that to be the case at Holmer Care Centre. We have served another Statutory Requirement Notice about the management of medication, and we will be returning to the home to check whether or not the providers have complied with this. PLEASE NOTE: Although this report does not show any requirements which are still outstanding, this is because we have made so many visits to the home recently that they do not yet show on our system. The requirements which remain outstanding are detailed in the reports of our previous inspections. 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 7 of 11 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 8 of 11 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 1 8 12 (1) You must ensure that an effective system is in place to manage the risk, and management, of pressure sores. This is so that people are not at risk of harm. 19/09/2010 2 8 13 (5) You must put an effective 19/09/2010 system in place to ensure that peoples mobility needs are safely met, in accordance with good practice. This is so that people are not at risk of harm. 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 8 12 (1) You must ensure that an effective system is in place to manage the needs of people with diabetes, in accordance with good practice guidelines. This is so that people can be confident that diabetes is managed safely. 29/09/2010 Care Homes for Older People Page 9 of 11 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 Care Homes for Older People Page 10 of 11 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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