Inspection on 08/01/07 for Holmer Court

This inspection was carried out on 8th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Court 08/01/10

Holmer Court 09/02/09

Holmer Court 19/03/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmer Court Attwood Lane Holmer Hereford Herefordshire HR1 1LJ Lead Inspector Philippa Jarvis Key Unannounced Inspection 09:30 9 &14th January 2008 th 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 Court DS0000067474.V351851.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 Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmer Court Address Attwood Lane Holmer Hereford Herefordshire HR1 1LJ 01432 351335 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) showard@ashberry.net Ashberry Healthcare Limited Vacant post Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th March 2007 Brief Description of the Service: Holmer Court is a large Georgian house with modern extensions, situated on the outskirts of the city of Hereford. It is registered to accommodate up to 32 older people whose care needs may arise from frailty due to the ageing process or a dementia illness. All rooms are single, apart from one, which is shared by two people. Twenty rooms have en-suite facilities. There are a range of communal rooms and good-sized gardens that are accessible for service users. Ashberry Healthcare Ltd bought the home in July 2006. The current weekly fees are between £470 and £495 a week. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a full inspection of Holmer Court to look at how the home is performing in respect of the core national minimum standards. The report says which these standards are. We call this type of inspection a key inspection. The information used in this inspection was gathered in a number of ways. The manager designate completed a quality assurance review (referred to in the report as an AQAA) for the commission. We sent survey forms to some people who live in the home, to some relatives and to some staff. A reasonable response was received with replies from ten residents and from twelve staff. We only received one response from a relative. We visited the home twice, the first time was unannounced and the second was by arrangement. During the two visits we spoke to the manager designate, some residents, some visitors and some staff. We toured the building and we spent time observing how people pass their time and what the arrangements were at teatime. Throughout the inspection there were opportunities to observe staff contacts with people living in the home. We checked documentation including the care records of four people who live in Holmer Court, some staff files and some records relating to the management of health and safety within the home. Information in the brochure showed that weekly fees range from £470 to £495. Additional charges are made for items such as dry cleaning, transport, private physiotherapy, optical care, dentistry and podiatry, and personal requirements – toiletries, newspapers, clothing, continence requirements, hairdresser. What the service does well: Holmer Court provides the residents with a safe, secure and friendly environment. The premises are well maintained and kept very clean. There are large, secure gardens where residents are able to move around freely. There is also space inside for those who are restless. There is information about the home available for people considering it as a home. The assessment and admission procedures are suitable. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 6 Staff are caring and respectful towards people living in Holmer Court and understand the importance of treating them as individuals. We saw and heard examples of staff treating the residents with sensitivity and respect. Visitors to the home were complimentary about the way that their relative was treated. Care is taken to make sure that recruitment is carried out thoroughly and that the right people are employed to work at the home. New staff undertake a carefully planned induction. The approach to the management of health and safety is good. Care is taken to ensure that required checks and tests on equipment in the home are carried out with the required frequency. All checks to fire safety equipment have been done and staff have received training about what to do in the event of a fire. What has improved since the last inspection? What they could do better: The service needs to have a registered manager who is legally responsible for leading the service. The manager designate does not have a deputy manager to lead the home in her absence. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 7 There have been a significant number of staff who have left Holmer Court over the last twelve months and the staffing establishment is now low. The home is trying to recruit new staff but the shortage of personnel has lead to shortages on the staff rota. There are aspects of the assessment of peoples dietary requirements and of the provision of a suitable diet that need attention to ensure that people get a balance diet that is provided for them in a way that is best suited to their individual needs. 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 Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 8 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 Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 9 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): 1, 2 and 5. Intermediate care is not provided at Holmer Court. Quality in this outcome area is adequate. The home obtains information about prospective residents’ needs so that they can be sure that they can offer them the care that they need. There is written information available for residents to provide them with information about the care provided in Holmer Court. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents are provided with a Service User Guide, which is in their room. This has been revised. There is a statement in the guide that indicates that it can be made available in alternative formats if requested but no attempt has been made to ask residents whether they would like this facility. For example there are several people with visual impairments who live in the home who Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 10 might appreciate a tape or large print document. The information provided about the outcomes from the last inspection we carried out is incomplete. The files we examined of people who had been recently admitted to the home all contained an assessment of needs that had been carried out before admission. The manager designate said that prospective residents are always encouraged to come and look round the home before deciding whether to come and live there. One person was doing this on the first day of the inspection. She actually moved in on the second day of the inspection. Notes about her care needs assessment were on her file but these had not been written up for the staff to read. When people move in it is always on a month’s trial basis so that they can decide whether they like Holmer Court and the home can confirm that they can meet their needs. The home also ensures that it receives a copy of the care needs assessment from the social services department if there is a social worker involved. The information contained in these documents forms the basis of the care plans. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 11 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, 9 and 10. Quality in this outcome area is adequate. People living in Holmer Court feel well looked after by the staff and have their health care needs attended to. The care planning practice that underpins the provision of reliable and consistent care needs to continue to develop to ensure peoples care needs are carefully identified and appropriate guidance provided for care staff at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us in their surveys and when we talked to them that they feel the staff look after them well. They all looked well presented and visitors that we spoke to confirmed that their relative was always well cared for and their personal appearance was appropriate. One relative said“It’s wonderful. The staff are always so caring.” Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 12 We looked at the files of four residents. They each had plans of care to provide information to the staff about the care to be given to that person. The new style of care planning that was being introduced at the time of the last inspection is now more firmly on place for each person. We found examples where the guidance needs to be more detailed do that it is more individualised and more specific. We saw one record that indicated a person needed a soft diet but there was no clear guidance as to how this should be provided or whether the person needed assistance. Another care plan did not provide clear guidance about the type of assistance a resident needed with their personal hygiene or management of their continence. The evaluation of the care plans was not always carried out on a regular basis. This meant that information about the way care was provided was not detailed might not be up to date. We read one file where the resident had lost a significant amount of weight and although action had been taken to deal with this nothing had been recorded about actions taken by the home. The home does not keep a daily record for each resident. Anything significant should be recorded as part of the evaluation of the care plan. If this evaluation is not written regularly the home might have difficulty monitoring residents progress. Holmer Court recognise the importance of all staff being involved in this process and they are encouraged to keep appropriate records. When we looked at the daily charts kept about the personal care given to each person, there were significant gaps in the recording that meant for example that it was uncertain when people had last had a bath. There are a number of male carers and residents can choose to have their personal care provided by one of them. There needs to be more guidance to staff about the management of people with behaviours that challenge the service. This needs to be specific and individual for each person. This will help staff to manage difficult situations and to ensure the personal safety of all in the home. We saw risk assessments on the files of the residents. Some of these had not been reviewed regularly to ensure that the information in them was up to date. For example one resident had fallen twice but there was no review of her falls risk assessment. There was no evidence of the involvement of the residents and their relatives in the preparation of the plans or approval of the content. People told us that they felt their health care needs were well looked after. We saw a record in each file of contacts that the resident had with health care professionals and details about the outcomes. For example where residents were identified as having pressure area care needs these had been assessed and appropriate equipment provided. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 13 We watched the staff with the residents and they were always polite and caring. We saw a number of occasions where matters were dealt with in a way that promoted peoples dignity. We watched part of one medication round. The drug trolley was kept in an orderly manner although it was very full. The member of staff on duty was careful to check the medication to be provided to each person before giving it to them. Care must be taken to ensure that the record of administration is not signed before the medications are actually administered. The practices of the home are audited by the pharmacist who supplies the home, and at the last audit in October 2007, he found most practices satisfactory. All the staff who handle the medication have received training in how to do this safely. Holmer Court DS0000067474.V351851.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 adequate. The progress being made to develop the range of enjoyable pastimes has recently slowed down although it is recognised as an important element of good care. Visitors are welcomed into the home and community links are encouraged. Most of the residents enjoy their meals although further consideration needs to be given to the provision of suitable food for people with specific dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home obtains information about the background of each person living there so that they have information to help them to continue living in the way they prefer. This includes details of hobbies and activities before they were admitted. There are photographs displayed in the home of residents participating in events that had taken place in the Holmer Court. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 15 The home is keen to promote activities and there were a number of seasonal events over the Christmas period. In their surveys the staff commented on the range of activities that were provided and generally considered this to be one of the things that the home did well. One of the senior care assistants has been given a special responsibility for activity organisation. Staff shortages have meant that she has not been able to work in this role over recent weeks although there is a programme of daily activities starting 14th January for the care staff to follow. There is an ongoing record of what each person has done. There may be benefits to linking this more closely to the main care plan to make the activity more integrated to that persons plan of care rather than an add on. The home is developing into a specialist dementia care home and staff would benefit from training in the provision of activities for people with these illnesses. There is a large enclosed garden that is a particular feature of the home and enjoyed by several residents. The manager plans to create raised beds so those with restricted mobility can garden there easily if they wish. Visitors feel welcome at Holmer Court and say they can visit there at any time. They said that the home communicates well with them and that the manager is always approachable to talk about any issues. The menus show that the meals are based on traditional home cooking. The main cook has not done any training in the dietary needs of older people; her experience is based on home cooking. We looked at the menus and it was evident that five portions of fruit and vegetables were not provided each day. There was a bowl of fresh fruit available in the dining room for people to help themselves. Those spoken with said that they enjoyed the food provided. There is a choice of food at breakfast including cooked items. There is no choice at lunchtime although residents can request an alternative to the main meal if they prefer. Three courses are provided at teatime for residents to choose from. There are a number of residents who have a soft diet or who lack the ability to eat with a knife and fork. Their care plan is not specific about the how their food should be presented to them. Tea on the first day was given to them all in a liquidised form in the way that considered each persons needs. Omelette and baked beans liquidised together looked most unappetising. More consideration should be given to providing people with an option of finger foods routinely as a means to promoting their independence and enjoyment of food. Some residents would benefit from a full nutritional screening, such as provided in the MUST (Malnutrition Universal Screening Tool). We saw staff encouraging and assisting people with drinks. These were provided at regular intervals throughout the day. Holmer Court DS0000067474.V351851.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. Residents and relatives know how to raise any concerns and feel confident that the staff will listen to them and take any necessary action to put things right. There are whistleblowing and adult protection procedures in place and staff are aware of the importance of reporting abuse although they need further training in this area to make sure they are fully able to recognise and report any abusive practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident is given information about the homes complaints policy and there is also a copy by the front door. In their surveys the residents all said they would know how to make a complaint. The home has received one complaint during the last year and there is information in their complaints log to show how they have looked into this. Visitors spoken with said they would have no hesitation raising concerns with the manager but that they had not had any need to do so. Staff we spoke to said they would not hesitate to report to the manager if they thought that someone was being abused or neglected. The training matrix provided by the home showed that there was a significant number of staff who Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 17 had not received training in safeguarding (adult protection) although the AQAA reported that they had provided training for all staff in this area. We were told that further training is planned for this year. The home has a whistleblowing policy. Due to their dementia illnesses residents occasionally be restless, aggressive or confrontational. These issues can at times have an impact on other people living in the home where some are also physically frail. Staff expressed concern about the management of one particular situation that was putting strain on them. We observed staff dealing with residents in a very calm way and showing a flexible and sensitive approach to people who were restless. Holmer Court DS0000067474.V351851.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): Quality in this outcome area is good. The accommodation provides a pleasant, clean and well-maintained environment for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated on the outskirts of Hereford city. The front of the building is on the roadside and car access is unsightly. There are large, accessible and secure gardens to the rear. We looked round some areas of the residents’ accommodation within the home and found that it was well maintained, clean and smelled fresh. Residents and their visitors confirmed that the home was always kept clean. Staff within the home have identified that they would like cleaners on duty throughout the day and the manager is in the process of reorganising the cleaning arrangements to address this. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 19 Most areas of the home were warm, although problems with one boiler meant that a few rooms did not have heating when we arrived on the first day. This problem had been reported and was dealt with by heating engineers that day. There is a full time maintenance person who deals with routine maintenance as well as ongoing repairs. The communal rooms are bright and pleasant. The dining room furniture has been replaced since the last inspection and this is a more pleasant area than previously. We noted that one small room, that is an additional lounge area for residents, was in the process of being converted into a new office. This is a change in facilities available for residents and this change of use should be formally notified to us. All but one bedroom is for single occupancy. Most of those viewed were well personalised to the residents choice and provided a comfortable individual room for them. The home aims to provide smart door signs in large print for each person; unfortunately some had been removed by a resident. The shared bathrooms and toilets were all clean. They had grab rails, bath hoists and some had space for disabled access. They were all fitted with paper towels and liquid soap and alcohol gel, which is good infection control practice. Each bathroom had a thermometer and a record was kept of the temperature of the bath water. Water temperatures are regulated and regular checks are undertaken. In addition all the radiators we saw wee guarded or have a low surface temperature. On the first day that we visited the laundry was not well kept. There were large piles of dirty items thrown on the floor waiting to be washed and significant amounts of clean washing on rails to be returned to residents’ rooms. This constituted an infection hazard. We were told that the laundry assistant had not been available for several weeks and the care staff were doing the laundry in addition to their caring tasks. By the second day of inspection the laundry assistant had returned to work and the laundry was maintained in a more organised manner. A number of staff have attended training in infection control. A portable air conditioning unit has been installed and the temperature in the laundry was reduced from the time of the last inspection. Holmer Court DS0000067474.V351851.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, 29 and 30. Quality in this outcome area is adequate. The staff group is hardworking and provides the residents with appropriate care and warm and meaningful human contact. There are times when the staffing levels are not sufficient to ensure that the staff have the time to deal with the complexity and range of care needs in the home. New staff are carefully selected and they are supported as they get used to the work. Staff are receiving the training they need to work safely with the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents and their relatives commented on how kind and helpful the staff were. They said that they were friendly and hardworking. We looked at the staff rota for two weeks around the time of the inspection. There were some gaps in covering the shifts. The manager designate explained that they were in the process of recruiting more staff as some people had left but confirmed that there had been times when the home had not had the full staff complement. There has been a significant turnover of staff in the last year. She also wants to recruit some staff to provide cover on an as required basis. In their comment cards the staff all responded that most of the Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 21 time staffing levels were satisfactory but sometimes they were short staffed. We observed that staff were busy throughout the time of the inspection. The care staff had also covered work in the laundry for some weeks due to the absence of the laundry assistant. This had impacted on the time they had available for working with the residents. The senior with delegated responsibility for activities was working as a carer to cover shifts rather than as an activities organiser. However we observed that during the afternoons in particular the care staff had time to spend with residents on an individual basis and that they worked with them in a group activity on the second day of the inspection. We checked staff recruitment records and these were satisfactory. They were kept in an organised way. There was a separate file with evidence of staff s identification and their CRB form. Each person also had a file that contained copies of certificates following training that they had completed. Following recruitment staff follow an induction programme for the first few weeks and they work with more experienced staff to learn how to do the work properly. Care is taken not to ask new staff to do work that they do not feel ready to deal with, one example given was with regard to the provision of care to a terminally ill resident. They then enrol on NVQ training. Information in the AQAA indicated that 50 of the care staff have an NVQ or are working towards this qualification. The manager designate has achieved the Registered Managers Award and has enrolled to take an NVQ 4 in care. There is an active programme of staff training. Whilst all staff have not completed all mandatory training e.g. Adult protection, most staff have taken the courses that they need so that they understand how to provide care safely. Recently 18 staff have completed a 12 week NCFE certificate in Dementia Awareness. Those spoken with said that this training had helped them understand better how to meet the needs of people with dementia illnesses. There has also recently been staff training in fire safety, infection control and moving and handling. There are aspects of training for some staff that need attention, for example dietary needs of older people and activity development. Holmer Court DS0000067474.V351851.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 adequate. The home does not have a registered manager as required by legislation. The manager designate is gaining experience and training and is being supported by the company to manage the home during this time. The health, safety and welfare of the residents are promoted well within the home by the promotion of safe working practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is no registered manager in post. The manager designate is supported by the operations manager for the company and by the manager of a nearby Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 23 nursing home within the same company. We were told that a deputy manager would be recruited to support her but this appointment has not been made. The manager designate is working very hard to ensure the efficient running of Holmer Court and to make certain that all the people living there receive a good quality of service. She is committed to promoting standards and there is evidence of improvements in a number of areas since the last inspection. However, there remains work to be done for the home to run smoothly and to comply with all legislative requirements and the manager designate would have benefited from additional on site management support. She is taking relevant training to provide the knowledge base for the management role. Relatives visiting the home commented on how approachable the manager designate is and that she always finds time to speak with them. The Operations Manager visits the home every other week and in addition to providing support and supervision for the manager designate, also writes a monthly report about the progress of the home. This is a legislative requirement under Regulation 26. The home has a quality assurance system and residents, their relatives and staff are given a questionnaire to complete 6monthly to provide their views about the home. The information provided in these has not been analysed. There is a clear and accountable system in place for managing and recording residents expenditure. There is a procedure for the formal appraisal and supervision of staff. In the AQAA the manager designate indicated that she is aware that this is an area of practice that is in need of development. The staff do consider that they receive informal support on an ongoing basis. They said that there is always someone they can talk to if they want. We looked at a range of records and certificates related to safe working practices, such as fire safety, servicing of equipment and regulation of water temperature. All those we requested were available and were kept up to date. The maintenance man has responsibility for carrying out regular checks and tests and their recoding. These were all accountable. An accident record is kept. This is well detailed and a monthly audit is carried out of all accidents in the home. The manager designate said that all the senior care staff working in the home have completed a First Aid at Work qualification; there are therefore always trained staff on the premises. Holmer Court DS0000067474.V351851.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 2 X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 X 3 Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 OP31 Regulation 8 Requirement The service provider must put forward their proposals for ensuring that there is a registered manager in day-today control of the home. This will ensure that residents live in a home that is run and managed by someone who is appropriately qualified, competent and experienced. Care plans should be reviewed by care staff at least monthly, and updated, so that they reflect peoples changing needs and provide up to date guidance to staff about the care to be provided. Timescale for action 29/02/08 2 OP7 15 29/02/08 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 OP1 Good Practice Recommendations The registered persons should produce a Service User DS0000067474.V351851.R01.S.doc Version 5.2 Page 26 Holmer Court 2. OP7 3. OP7 4. OP8 5 OP15 6 6 OP27 OP36 Guide in alternative formats suited to the needs of the residents. This recommendation is repeated. Care should be taken to ensure that the guidance provided in care plans is precise enough so that staff have clear information about what they need to do to provide the right care. Care should be taken to assess each person’s dietary needs and to provide individual guidance where issues are identified so that peoples experience of the provision of food is improved. Specific guidance should be provided about how to manage aggressive or challenging behaviours for each resident where this is relevant. This will help to protect everyone in the home and enhance the quality of experience for that individual. The person leading the provision of food in the home should receive training in how to meet the dietary requirements of older people and people with dementia illnesses. This will help to ensure that people living in the home receive a diet that suited to their needs. Care must be taken to ensure that there are enough staff on duty at all times to cover all the functions required in the home. The formal supervision and appraisal of staff must be carries out with appropriate frequency. This will ensure that the staff and the management of the home have dedicated time to discus staff professional development and training needs. Holmer Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection 77 Paradise Circus Queensway Birmingham B1 2DT 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 Court DS0000067474.V351851.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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