This inspection was carried out on 5th October 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOMES FOR OLDER PEOPLE
Holmer Care Centre Leominster Road Hereford Herefordshire HR4 9RG Lead Inspector
Sandra J Bromige Unannounced Inspection 5th October 2005 01:00 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.V256501.R01.S.doc Version 5.0 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.V256501.R01.S.doc Version 5.0 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) 0845 455745 01432 342390 Mrs S Roberts Mr Jeremy Peter Ewens Walsh Mrs Susan Marshall Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (35) Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1. Two named service users with dementia under the age of 65. Date of last inspection 26th January 2005 Brief Description of the Service: Holmer Care Centre is on the outskirts of the city of Hereford. It is owned and managed by The Holmer Partnership, Blanchworth Care. The Home was first opened in December 1991. It is a Victorian property that has been extended to provide a Care Home with nursing for a maximum of 35 older persons over the age of 65 years, of both sexes, who have dementia or a mental disorder. Fifteen bedrooms are single occupancy, four have en-suite facilities. The Home has a passenger lift. The Home operates a ‘locked door’ policy, as indicated in the Home’s Statement of Purpose and Service User guide. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 13.00 – 16.15 hrs on the 5th October 2005. Information has been obtained through observation of parts of the premises, and care practice. Information was also gathered from looking at residents and staff records. A number of staff including the manager, residents and a relative were spoken with. Comment cards were sent to the Home in July 2005 for distribution to residents and relatives. None have been received by the Commission to date. There were no comment cards on display at the entrance to the Home for relatives and visitors to pick up and complete and the manager confirmed that not many had been given out by the Home. The Provider has received a complaint since the last inspection alleging poor care practice. The Provider is currently investigating this complaint, although the Commission has investigated elements of the complaint. Two unannounced visits were made to the Home at the end of March and the first week in April 2005 and a letter sent to the Provider detailing the findings. A follow up visit was made by the Commission at the beginning of May 2005 to monitor the Homes actions. The Commission was not satisfied with the findings and an immediate requirement notice was left at the Home and a letter sent to the Provider. The requirement has now been fully met by the Home. What the service does well:
The Home is situated on the outskirts of the City of Hereford, which is close to local shops and amenities. The manager and staff make visitors very welcome in the Home. There was a very calm and peaceful atmosphere in the Home on the day of the inspection. Residents were sat in the three lounge dining areas and they all appeared comfortable, appropriately dressed and the men were nicely shaven. Resident’s clothes were nicely laundered. Staff showed a kind and gentle approach towards residents. A relative said that they were ‘very happy with the care and the staff are very kind’. They also said that ‘they are involved with the periodic review of their mothers care needs’. Staff were observed giving out afternoon tea and cake and assisting residents to eat and drink in a discreet and unhurried manner. A support group is provided by the Home for relatives of the residents and the next meeting was due to take place this month. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 6 Staff have a good knowledge and understanding of recognition of abuse and alongside robust recruitment procedures this provides a safe environment for the residents in the Home. The Home is well managed promoting and safeguarding the health, safety and welfare of the people using, working at and visiting the service What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 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.V256501.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 There is a comprehensive care planning system format in place, but the standard of recording is not consistent to provide staff with the information they need to ensure a reliable standard of care is maintained. The health care needs of residents are met with evidence of multi disciplinary working with other healthcare professionals taking place on a regular basis. EVIDENCE: Individual plans of care are available for each resident. Two care records were seen. One was very comprehensive and had been reviewed each month. The second care plan was not written to the same standard. It had not been reviewed each month, including areas where the resident had specific problems such as being at risk of falls and poor nutrition. The care plan for a recent small injury to the residents arm had not been reviewed each day as prescribed, although trained staff reported that this had now healed. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The Home has a satisfactory complaints system enabling people to air their views about the service. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect residents from abuse. EVIDENCE: The Homes complaints procedure is on display at the entrance to the Home. The Provider has received a complaint since the last inspection alleging poor care practice. The Provider is investigating this complaint, although the Commission has investigated elements of the complaint. Two unannounced visits were made to the Home at the end of March and the first week in April 2005 and a letter sent to the Provider detailing the findings. A follow up visit was made by the Commission at the beginning of May 2005 to monitor the Homes actions. The Commission was not satisfied with the findings and an immediate requirement notice was left at the Home and a letter sent to the Provider. The requirement has now been fully met by the Home. Staff recognise and report any allegations of abuse using the local procedures for Protection of Vulnerable Adults. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Good practice and procedures by staff are in place for the management of infection control. EVIDENCE: A large extension is in progress of being built at the Home. The first phase of the extension is finished and the top floor bedrooms of the extension are in use to enable the next phases to be completed. New doors and locks have been fitted to the existing Home’s bedrooms. There was no building work in progress on the day of the inspection despite areas of refurbishment such as toilets by the dayroom being only partly completed. The Commission have written to the Provider to bring these concerns to their attention, as there is concern about the management of infection control in these areas. Painting of parts of the premises was in progress. Despite the extensive work that is taking place, the Home is clean and tidy. One bedroom has a bad odour and this has been identified and a new carpet is on order. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 The number of staff available was sufficient to meet the needs of the residents. The procedure for the recruitment of staff is robust providing protection to people living in the Home. EVIDENCE: At the time of the inspection there were two trained staff and six care staff on duty for 34 residents. The electronic staff file of a recently appointed member of staff contained all of the information required by legislation. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The Home is well managed promoting and safeguarding the health, safety and welfare of the people using, working at and visiting the service. EVIDENCE: There was a first aider on duty at the time of the inspection. The manager confirmed that all trained staff except two have completed there first aid training and all staff have received moving and handling training. Discussion with staff confirmed that they have received core health & safety training such as fire, and moving and handling. Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 16 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 OP7 Regulation 15 Requirement Care plans must be reviewed each month and kept up to date. Timescale for action 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holmer Care Centre DS0000027681.V256501.R01.S.doc Version 5.0 Page 17 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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