Inspection on 20/07/10 for Holmer Care Centre

This inspection was carried out on 20th July 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 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 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 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: 2 0 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 17 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 17 What we found: We visited Holmer Care Centre for the second time within eight days because Herefordshire Council had made us aware of some further serious concerns about the home, including the fact that the new manager had left 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. We found some further areas of serious concern, and we have provided information about these to Herefordshire Council, under its procedures for safeguarding vulnerable adults. We have grouped our evidence under headings, to make it easier for people to find relevant information. The report of our previous inspection, carried out on 12 July 2010, should be read with this report to gain a fuller picture of the home. DEMENTIA CARE We explained in our previous report that Holmer Care Centre specialises in caring for people with dementia. We also described the kind of care which people with dementia should be able to expect. The Alzheimers Society explains: 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. We saw that people were still aimlessly walking around the home, or sitting in the lounges or their bedrooms with nothing to occupy them. Although we had made some suggestions the previous week about ways in which the home could easily and quickly provide some sensory stimulation for people, for example, by providing rummage boxes of textured fabrics, we were disappointed to see that nothing had been done to improve peoples daily lives. The only positive change in this area was that there was music playing in the lounges. The previous week, we had seen that one person who stays in their bedroom for most of the day did not have any means of calling for assistance, as their call bell had not been placed within their reach. We went to see the person in their bedroom, and found that again the call bell had been left out of their reach. The person was not able to move witout help, so would not have been able to call for assistance. We made an immediate requirement that the home must put an effective system in place to ensure that people are able to access assistance when they need it. BEHAVIOUR We saw that one person had been described in the daily records as restless and intrusive, other residents becoming angry and A (name of person) also becoming agitated and aggressive. We saw that there was no care plan to tell staff how to manage this behaviour. Care Homes for Older People Page 4 of 17 We observed the person in a lounge during the afternoon. There were no staff present in the lounge. The person was becoming agitated, walking round the room touching people and pulling at them. One of the other people in the room appeared to be getting angry. We asked staff to intervene, and they gently assisted the person to leave the lounge. We have written to the provider and required her to put an effective system in place to ensure the safety of people using the service, within a very short timescale, as people are clearly at risk of injury. MOBILITY We saw two staff supporting someone to walk from the lounge. The person did not appear to be able to bear their own weight, and staff were using a technique known as an underarm drag to support the person. This places the person at risk of harm, as it places strain on the underarm area and can cause dislocation and fractures. The manager intervened to ask staff to fetch a wheelchair. We checked the persons records, and these stated that the person could walk unaided. The assessment had been carried out only a few days previously. We spoke to a staff member, who was able to give a clear explanation of the persons mobility needs. This means that care plans are not always up to date, and this puts people at risk of injury, as staff may not know how to support them. HEALTHCARE Records showed that one person has low blood pressure, and a member of staff described the person as having dizzy spells, which are a symptom of low blood pressure. There was no care plan in place to tell staff how to manage the persons low blood pressure or their other health needs, such as Parkinsons disease. We saw that the GP had visited the person and had requested that staff should take the persons blood pressure twice a week. Records showed that blood pressure readings had not been recorded as the GP had requested. Records showed that one person had had a wound which had caused some bleeding. A care plan had been drawn up, which clearly explained how the wound should be managed. The care plan stated that the wound should be re-evaluated in three days time. There was no evidence of any re-evaluation and the wound was not recorded on the body map diagram. Body maps are outline drawings of the human body, used to record any wounds or injuries, and should be completed whenever anyone sustains an injury. We checked other peoples care plans, and found that the body maps had generally not been completed. RECORD KEEPING As we have described, some care plans were not up to date and did not contain current information. This is particularly important in a care home like Holmer Care Centre, where agency staff, who may not know the needs of the people who live at the home, are often employed. We saw that the interim manager has begun to update the care plans, and she told us Care Homes for Older People Page 5 of 17 that this would be a priority for her. There was some evidence of good record keeping. For example, one person has several food allergies, and these were clearly recorded in the care plan. Staff knew about the allergies and were able to explain which foods should be avoided. MEDICATION When we arrived at the home, there was only one registered nurse on duty. The interim manager told us that another nurse would be arriving soon. The registered nurse was carrying out the morning medication round upstairs. This medication round was due to have started at 09:00, but the nurse explained that it was delayed because she had needed to carry out the medication round downstairs first. We saw that the upstairs medication round was not completed until 11:40. This means that some people who are due their medication at 09:00 did not receive it until 11:40. This is an unacceptable delay, and it concerns us that the home had not put this right, even though this had happened at our inspection the previous week. EATING AND DRINKING We had previously expressed concern that there were no drinks freely available for people. When we checked in the lounges, we saw that jugs of cold drinks had been placed on shelves, with brightly coloured plastic beakers. Unfortunately, during the day, we did not see any of these drinks poured for people or placed where they could easily reach them. There were bowls of fresh fruit in each lounge. We checked to see if one person who is at risk of dehydration was being given adequate drinks. The records showed that the person had had plenty to drink, and we saw that there were drinks available in their bedroom, and that they appeared to be well hydrated. In another bedroom we did not see any drinks available. Staff told us that some people are at risk of spilling drinks if they are left unattended. If this is the case, we would expect to see a care plan which explains clearly to staff how they can ensure that the person gets enough to drink. PROTECTION At the previous inspection, we had found that the home was not always notifying the appropriate authorities of incidents where people had been injured. We saw a photograph in one persons care plan which showed a very large bruise. The photograph was not dated and there was no other record of the injury. This means that the home has failed to carry out its responsibilities to protect peoples safety and wellbeing. The fact that there are no staff based in any of the lounges could place people at risk of harm, as care plans and other records show that some peoples behaviour could put them or others at risk. We saw that one person who has previously has episodes of challenging behaviour was in a lounge where there were no staff, and no staff entered the lounge for over ten minutes. ENVIRONMENT Generally the home is dirty and unhygienic. We saw that carpets were heavily stained throughout the home. The lounges have laminate floors, and we found bacon scraps on Care Homes for Older People Page 6 of 17 the floor of one of the lounges after a cleaner had supposedly cleaned the room. We also found a large amount of food debris on the floor of a lounge more than an hour after lunch had finished. This is unacceptable in a care home, as it poses a serious risk to people living at the home. We spoke to several relatives of people who live at the home, and they all told us that the home often smells of stale urine, and that it is usually dirty. One visitor told us that they change their clothes when they return home after visiting Holmer Care Centre, because I feel that I smell when I go out. Another person said that they always bring a towel with them to put on the chairs as the chairs are so dirty. We saw that the chairs in the lounges were generally dirty, and some of them felt sticky to the touch. Many of the chairs were stained and the upholstery was torn and in a very bad state of repair. It is not acceptable that people should have to live in such unhygienic conditions. STAFFING The staff on duty were kind and cheerful, and all the visitors we spoke to told us how hard they work. Visitors also told us that they consider that there are not enough staff on duty. They told us about many occasions when there are no staff in the lounges. When we arrived at the home at 09:45, there was only one registered nurse on duty. The interim manager told us that another nurse would be arriving soon. The second nurse did not arrive until 11:10. This meant that there was only one registered nurse on duty, and she was not available to carry out any nursing duties because she had both the downstairs and upstairs medication rounds to carry out. We say more about this in the section on Medication. We spent some time during the day in three of the four lounges. There were no staff based in any of the lounges. Although staff occasionally came in and out of the lounges, this was always to carry out a task, such as fetching trays or taking someone to the toilet. We did not see any staff taking time to sit and chat with people. MANAGEMENT Since our previous inspection, the newly appointed manager has left. The provider has asked one of the Operations Managers to manage the home until a new manager can be appointed. This Operations Manager has previous experience of managing a care home. She was able to tell us how she would be making sure that there are prompt and effective improvements made within the home. The home has sent us an action plan which decsribes how they will be addressing the issues we raised at the previous inspection. We will be working with the Local Authority under its procedures for the protection of vulnerable adults to monitor the improvements and take appropriate action to ensure that peoples safety and wellbeing are protected. What the care home does well: Because this inspection was focussed on areas of concern, we may not have identified all areas of good practice. Care Homes for Older People Page 7 of 17 Staff are kind and caring, and people told us how hard they work. Fresh fruit is available for people at any time. 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 17 Are there any outstanding requirements from the last inspection? Yes R No £ 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 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 10/08/2010 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. 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 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 Page 9 of 17 Care Homes for Older People 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 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 ensure that 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. 7 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 Care Homes for Older People Page 10 of 17 10/08/2010 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 prescribed. 8 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. 9 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 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. 10 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. 11 12 16 (2)(n) You must ensure that people have access to recreational activities and facilities which meet their individual needs. 10/08/2010 Care Homes for Older People Page 11 of 17 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 This is so that people are able to occupy themselves as they wish. 12 18 13 (6) You must ensure that 10/08/2010 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. 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 harm. 15 38 37 You must put an effective system in place to ensure that the Commission is 10/08/2010 10/08/2010 Care Homes for Older People Page 12 of 17 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 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. Care Homes for Older People Page 13 of 17 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 put an effective 22/07/2010 system in place to ensure that people are able to access staff assistance at all times. This is so that peoples needs can be met in a timely manner. 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) and (2) Care plans must 10/08/2010 be in place, and must be sufficiently detailed to enable staff to understand and meet the needs of the people who use the service. This is so that people can be confident that their needs will be met. 2 8 12 (1) You must put an effective 10/08/2010 system in place to ensure that staff carry out instructions made by a health professional such as a GP. This is so that peoples health needs are met. 3 8 13 (5) You must put an effective 23/07/2010 system in place to ensure Page 14 of 17 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 that peoples mobility needs are assessed and managed safely. This is so that people are not at risk of harm or injury. 4 8 12 (1) You must put an effective 23/07/2010 system in place to ensure that people using the service are not at risk of harm or injury from risks associated with their dementia care needs, for example inappropriate interaction with other people who live at the home. This must include the provision of adequate staffing resources to ensure their safety and to implement the care plans. This is so that people are not at risk of harm or injury. 5 9 12 (1) You must ensure that 10/08/2010 people receive their medications at the time that the prescriber has instructed. This is so that people receive their medication as prescribed. 6 26 13 (3) You must ensure that food debris is promptly cleaned up, especially after mealtimes. This is so that people are not at risk of harm or injury. 10/08/2010 Care Homes for Older People Page 15 of 17 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 8 You should ensure that the recording of injuries includes the use of a body map, so that the service can be sure that injuries have been accurately recorded. Care Homes for Older People Page 16 of 17 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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