Inspection on 21/02/07 for Holmer Care Centre

This inspection was carried out on 21st February 2007.

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.

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 12/07/10

Holmer Care Centre 08/01/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG Lead Inspector Wendy Barrett Unannounced Inspection 21st February 2007 14:30 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.V330521.R01.S.doc Version 5.2 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.V330521.R01.S.doc Version 5.2 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.V330521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. Three named service users with dementia under the age of 65. Date of last inspection 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. There is information literature describing the service displayed at the home and copies are available on the Provider’s 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 Provider’s website address. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written with reference to information about the service and held by the Commission, a pre-inspection questionnaire completed by the Provider, 5 relatives’ survey forms, 2 visiting health care professional survey forms and an unannounced inspection visit to the service. The survey form responses were too few to draw any general conclusion from this exercise. A CSCI pharmacist inspected Standard 9 (medication) as part of the key inspection. Some medicine stocks and records were examined and three members of nursing staff were spoken to. The medication inspection was on a Thursday and lasted 5 ½ hours. What the service does well: What has improved since the last inspection? The staffing level has been increased since the last inspection. There has been attention to previous inspection requirements to make sure the service complies with statutory requirements. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 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.V330521.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a contract of residence. New residents are only admitted once the home has the information required to decide if care needs can be met. EVIDENCE: Each resident receives a contract of residence so that they know what to expect from the service. The fees are specified in the contract. Residents are only admitted once the home has the necessary information to decide if it can meet the potential resident’s care needs and expectations. A sample of care records contained details of this pre-admission assessment work. The records included attention to personal and health care needs and, Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 9 when potential risks have been identified, the staff use recognised assessment tools to help them decide how to respond e.g. Prideaux Nutritional Assessment tool. The residents who are cared for at Holmer Care Centre often find it difficult to tell the staff about their past life. Therefore, information is gathered about families, previous occupations, leisure interests etc. This helps the staff to get to know each resident well and to respect their individuality. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has an individual plan of care so that staff know about current care needs and how to meet them. Every resident has a written plan of care so that staff know how to provide the care in a way that will meet needs and expectations. Although many of the residents are very dependent on the staff there is good reference to personal preferences. Relatives are often asked to help with this work e.g. a care plan mentioned ‘enjoys a large breakfast’. The plans also confirmed if the resident had any preference for a male or female carer and what time the resident liked to get up or go to bed. The records of actual care indicated that the staff were following the guidance in the care plans e.g. a preference for a shower was being followed through. Four relatives’ survey forms were complimentary of the way staff work with the residents –‘’nothing but praise for the staff’, ‘very good care provided to my husband’. One relative was not happy –‘Xmas presents still in wrapping into Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 11 the New Year’. Observations of the approach of staff during the inspection visit indicated a respectful manner with sensitivity and tolerance to the challenging behaviours of some residents. Comments from two Nurse Specialists indicated confidence in the standard of care. The staff regularly evaluate each plan so that they can adjust the plan according to any change in the resident’s condition. There are also review meetings with relatives and social or health care workers. Two such meetings took place during the inspection visit. The Care Manager felt well supported by the medical staff from the Department of Mental Health. There is a weekly visit to the home and staff can access them directly if they need guidance. This is good because the staff have to cope with significant care needs that require careful monitoring. Quality in this outcome area regarding medication is adequate. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. There are arrangements in place for the management of medicines but as a result of the inspection some issues of concern are noted where more attention to detail and regular checks are necessary in order to protect the health and wellbeing of service users. EVIDENCE: A CSCI pharmacist inspected Standard 9 (medication) as part of the key inspection. Some medicine stocks and records were examined and three members of nursing staff were spoken to. The medication inspection was on a Thursday and lasted 5 ½ hours. The Blanchworth Medicine policy dated April 2006 was available in the office. The way this particular home obtains medicines for PCT funded service users is different to normal practices. This was not apparently identified in the policy. As a part of the arrangements for the safe handling of medicines the medicine policy and procedures must tell staff exactly how medicines are to be handled in that particular service. There was a domestic remedies list but the copy in the policy file had not been authorised by the manager or a doctor. There is a staff signature list and recent medicine reference book together with the June 2003 guidelines from the Royal Pharmaceutical Society. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 12 There are records for the receipt, administration and disposal of medicines. FP10 prescription forms are collected from the surgeries by the pharmacy so are not checked in the home first, as is the best practice. For example a dose on the medicine chart for a pain relief medicine for a particular service users is 5ml twice daily but the bottle is labelled 5ml three times daily and this is the dose on the repeat prescription. The nurse said the doctor had changed the dose but this could not be evidenced in the care plan. Checking the doctors’ prescriptions in the home before they are sent to the pharmacy could help avoid this sort of occurrence. Copies of all prescriptions supplied from the hospital are kept. There was a discrepancy about the dose of another liquid medicine for one service user. The bottles of medicine dispensed on 5/2/07 were labelled ‘Two 5ml spoonfuls…’ but the medicine chart indicated a dose of ‘two to five ml…’. The medicine chart dose was correct when compared with the care plan but the medicine bottles had been labelled in accordance with the latest prescription, which stated a 10ml dose. Some medicine administration charts were looked at in detail. These were signed and checked by two nurses when written and generally appeared to be complete records. But on four charts there were eight gaps in the records so it is not known if a dose was given or missed. There is a standard code printed on the charts to use to indicate if a dose is missed. There was another example where a dose of 5 – 10ml is prescribed but the actual dose given is not recorded. The administration of some medicines at lunchtime to service users on the first floor was observed and discussed with the registered nurse. For one person the dose was prepared at the trolley located by the lounge in the old building then taken in a spoon to the service user’s bedroom. This is a considerable distance away at the far end of the corridor in the new extension. The lead inspector raised this issue at the inspection on 10th February 2006 when further advice was given and a requirement made. A new requirement has been made about this. In order to reduce risks to service users the labelled containers of medicines supplied by the pharmacy and the latest medicine administration chart must be altogether with the service user at the place where the medicines are given. This allows all the checks to be made to make sure that each service user is given the correct medication. Where two nurses are involved the person actually seeing the medicine taken should sign the record. The medicines must be kept safely during this period. For subsequent doses the nurse took the medicine trolley to the bedroom door or lounge area. The nurse on the ground floor said that this what is done on that floor. Four audit checks were made by counting tablets remaining in the trolley and comparing this with the calculated quantity that should be remaining according to the medicine records. There were discrepancies with each of these counts. This can indicate that medicine records are not accurate or that service users Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 13 have not had their medicines correctly. The manager must make random checks such as this as a method of regular audits. Six care plans were looked at where service users are prescribed some of their medicines to use ‘as required’. Two plans contained detailed information but three plans had no information. Another plan mentioned medication but as three medicines were involved at different doses more detail is needed. This sort of information is needed in care plans for any medicine prescribed to take ‘as required’ so that it is quite clear to all staff how to consistently use the medicines for the benefit of the service user. Locked medicine cupboards are provided and two medicine trolleys are used since the home extended. The cupboards are very full as a lot of medicines are used and many of them are liquids, which take up more room. Sufficient space has not been provided to cope with the extra medicines since the home extended. Medicines must be organised in a way to easily see what stock is available and in an orderly manner. There appeared to be excess stocks of some medicines. The door to the care office was left open. Whilst all medicines are kept in locked cupboards there are a number of medical items on open shelves so caution is need to prevent unauthorised access to these. Two medicines were wrongly stored which means that the medicines could breakdown and so this is in breach of regulation 13(2). Two bottles of a particular eye drop were stored in the main cupboard rather than the medicine fridge. An opened vial of insulin was in the fridge – the manufacturer’s directions specify not to store opened insulin products in the fridge. The dates medicine containers were opened were written in many cases but a number of examples were seen where this was not done. This makes it difficult to make sure medicines are used within the correct shelf life period. There were several very sticky medicine bottles in one of the medicine trolleys, which is not hygienic. There are two cupboards to keep controlled medicines. One cupboard needs more secure fixing to the solid wall in order to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 and this standard. It is strongly recommended that a particular liquid painkiller is stored in the controlled medicine cupboard and entries made in the record book. Arrangements are in place to dispose of medicines via a licensed waste contractor. Designated inactivation kits must be used for the disposal of controlled medicines before they are put in the waste medicine bin. The records should indicate this action. Satisfactory checks were made of entries and stock in the controlled medicine record book. There was no evidence of any regular checks being made of the record book. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are well supported in following a lifestyle of their choice despite their limited abilities. The catering service is well managed by a competent cook who understands what each resident needs and enjoys. The practice of preparing a corporate menu may limit the cook’s opportunity to design the most suitable meals for the particular resident group at Holmer Care Centre. EVIDENCE: An Activities Co-ordinator is employed at the home between 8am and 4pm five days each week. She was interviewed during the inspection visit and described how she spends time on group and one-to-one activities. The activities are designed to accommodate the ability of each resident e.g. some residents are able to enjoy flower arranging sessions, others respond best to simple activities like hand massaging. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 15 The Activities Co-ordinator was observed working with a group of residents in one of the lounges. This was a sing-a-long. Each resident received attention to try and help them get the best out of the activity and the Activity Coordinator was patient and encouraging in her approach. Residents were spoken to with respect and kindness and interruptions were treated with tolerance and acceptance. There has been little response from relatives to this survey exercise and that conducted during the previous inspection but visitors were seen arriving at the home and staff received relatives of a resident warmly when they came in for a review meeting. One resident was taken out for the day by a relative. The cook was interviewed. She was well aware of each resident’s dietary needs and their likes and dislikes e.g. soft diet and prefers small portions. The way meals are served has been improved since the last inspection. Hot puddings are now taken out of the kitchen after the first course is finished. This avoids the food getting cold before the resident is ready to eat it. A corporate menu is used although the cook agreed she has some flexibility. There is quite a lot of waste sometimes, which may suggest there is a need for more opportunity to adjust the meals to suit the particular resident group. Some residents benefit from plate guards and these are supplied. The kitchen was inspected by the Environmental Health Department in January 2007. The report confirms ‘very good standards and procedures noted’. A very appetising lunch of cottage pie, carrots and peas – followed by a raspberry trifle – was being prepared and served as close to lunchtime as is reasonable (all meals have to be plated up in the main kitchen due to the risks of doing this out in the home). Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given information to help them raise any concerns about the service. When this happens the staff respond appropriately. The residents are protected from abuse by staff who are given guidance to help them work safely with residents and who demonstrate an open approach in working with other professionals in investigating any relevant issues. The staff training should include attention to local protocols. EVIDENCE: There is a written complaints procedure to advise people how to raise concerns about the service. When this happens, a record is kept of the concern and any action taken by staff to address it. A copy of a response written by the Director of Care was seen. This gave clear details of action taken to address a relative’s concerns. The Provider and Care Manager have recently worked constructively with other professionals to investigate an allegation of abusive practice. In order to strengthen the protection of residents the Provider has introduced new policies regarding choice of movement around the home and in deciding which G.P. they will have. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 17 A training plan confirms that staff receive regular instruction to help them deal safely with challenging behaviour and to recognise and report abusive practice. This does not cover local arrangements and a requirement is made for staff to receive additional training to familiarise them with local protocols for the protection of vulnerable adults. This is particularly important as staff at Holmer are caring for residents who present considerable challenges in addressing their everyday personal care needs. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in accommodation that is managed to ensure they are as safe and comfortable as possible. Hygiene measures are generally satisfactory although the current sluice facilities could be improved. EVIDENCE: The premises are subject to regular maintenance so that the quality and safety of the residents’ accommodation is maintained. The home was not fully inspected during the inspection visit but those areas that were visited were clean, bright and generally odour free. A few residents’ bedrooms were seen. These were nicely presented to suit the individual’s needs e.g. some rooms had Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 19 carpet flooring, others were laid with hard flooring to allow easy cleaning, one resident had his own double bed and a card table and television. Work had been completed to address shortfalls identified at the last inspection i.e. the maintenance man has covered exposed heated surfaces and is checking some areas that tend to get damaged by residents, bedroom doors were not being wedged open at the time of this inspection visit. Infection control measures were satisfactory when the home was last inspected. Although staff have now been instructed to take commode pots straight back to commodes instead of stacking them while still wet after washing, the Care Manager acknowledged that the current facilities do not provide much space for fixing racks so that the pots could be air-dried before being returned to bedrooms. It is recommended that this problem should be given further consideration given the potential risks of cross infection. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs. They receive the training they need to work safely and competently. EVIDENCE: On the first day of the inspection visit there were 3 registered nurses on duty between 7am and 7pm. 6 care staff were at work during the day and an activities organiser was working between 8am and 4pm. There were a satisfactory number of catering and housekeeping staff to support the care service. This is a higher staff cover than was in place at the last inspection when it was not considered satisfactory so it is reassuring. No agency staff were being employed on the day although sometimes they have to be used. An interviewed care assistant felt that there were generally enough staff at work to meet the residents’ needs. Extra help was available during difficult periods. Staff referred to good training opportunities e.g. annual instruction in manual handling and handling challenging behaviours. The cook had undertaken a refresher food hygiene training course three weeks prior to the inspection visit. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 21 Records of overall staff training confirmed regular attention to health and safety training and professional practice training. Over half the care staff hold a national vocational qualification and others were working towards this award. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is managed by an experienced Provider. The service is run with attention to the particular needs of the resident group to ensure their safety and welfare and to allow them as much choice as possible. However, this approach will sometimes present staff with additional challenges that may require more robust support procedures for them. EVIDENCE: The Care Manager is supported by an experienced and well-resourced Provider organisation e.g. computerised records, regular visits from Provider Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 23 representative to audit the everyday management of the service, provision of up to date policies and procedures, intranet facility to distribute information to the public. There is an annual quality assurance plan that was last reviewed in February 2006. In the near future all registered services will be required to submit selfassessment information to the Commission and the current plan will support the Provider in complying with this new requirement. Residents’ personal money is not held at the home. When there is any expenditure, relatives or financial representatives receive separate invoices. This approach is considered good practice because staff should have as little involvement in managing residents’ financial affairs as possible. The Care Manager and Provider regularly oversee various records so that they can monitor the effectiveness of the service e.g. quarterly infection control audits and monthly accident report audits (examples were available at the home). There are a significant number of incidents involving challenging behaviours that have to be managed by staff. This is understandable because the home specialises in this type of care need. The Commission is being kept informed of events, as required. However, the support systems for staff need to be robust enough to reflect the particular demands placed on them as they go about their daily work. There is a policy addressing ‘aggression toward staff’ but this has not been reviewed since May 2004. Given the nature of the service a requirement is made to update this with reference to the number and nature of behaviours staff have to respond to e.g. training, debriefing, counselling facilities. The cook mentioned a recent and satisfactory inspection by an Environmental Health Officer and a pre-inspection questionnaire included copies of certificates to confirm contractual arrangements to service essential services e.g. water, gas, electrics. The questionnaire also confirmed implementation of relevant policies and procedures that are subject to regular review so they comply with current health and safety legislation. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 24 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 3 3 Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement The registered manager must make sure that procedures for administering medicines to service users follow accepted safe practice. The labelled container of medicines and MAR chart must be checked immediately before giving the medicine and adjacent to the service user with all medicines held safely whilst being taken around the home. The nurse witnessing the medicine as taken must make an immediate record on the chart when the medicine is seen as taken. The registered manager must make sure that medicine administration chart records are always complete and accurate – showing the actual dose administered in the record where a variable dose is prescribed and no gaps in the record charts. The registered manager must make sure that designated inactivation kits are used when disposing of controlled medicines. DS0000027681.V330521.R01.S.doc Timescale for action 15/04/07 2. OP9 13(2) 15/04/07 3. OP9 13(2) 01/05/07 Holmer Care Centre Version 5.2 Page 26 4. OP9 13(2) 5. OP9 13(2) 6. OP9 13(2) 7. OP18 13(6) 8. OP36 18(2)a The registered manager must demonstrate that regular checks are made showing that the arrangements for the safe handling of medicines are effective and service users receive their medicines correctly with accurate records always kept. The registered manager must make sure that when medicines are prescribed to take ‘as required’ there is a detailed plan to make clear to all staff how to consistently use the medicine for the benefit of the service user. The registered manager must review the medicine policy and procedures to make sure that the particular arrangements and procedures in this home are included. The arrangements for protecting residents from abuse must be strengthened through training of staff in local protocols for the protection of vulnerable adults. Staff supervision arrangements and associated policies and procedures must be reviewed to ensure they reflect the particular demands of the service i.e. challenging behaviours and aggression. 01/05/07 01/05/07 01/06/07 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Provide more locked storage space for medicines so that stocks can be safely arranged in an organised manner. DS0000027681.V330521.R01.S.doc Version 5.2 Page 27 Holmer Care Centre 2. 3. 4. 5. 6. OP9 OP9 OP15 OP26 OP36 Check and copy FP10 prescriptions from the doctor before sending to the pharmacy for dispensing. Store Oramorph liquid in the controlled medicine cupboard and make records for this medicine in the controlled medicine record book. Consider offering the cook additional flexibility in menu planning. Consider improving sluice facilities to provide space for racks so that staff can air dry commode pots before returning them to residents’ bedrooms. Review and update the ‘aggression towards staff’ policy as part of work to address Requirement No. 8. Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Holmer Care Centre DS0000027681.V330521.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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