Inspection on 14/09/05 for Holmers House

This inspection was carried out on 14th September 2005.

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

Holmers House 16/06/09

Holmers House 15/09/08

Holmers House 24/06/08

Holmers House 27/06/07

Holmers House 21/08/06

Holmers House 20/12/05

Holmers House 25/01/05

Holmers House 03/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Holmers House Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU Lead Inspector Christine Sidwell Unannounced Inspection 14th September 2005 09:30 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 Holmers House DS0000022979.V250247.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. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holmers House Address Holmers Farm Way Cressex Road High Wycombe Bucks HP12 4PU 01494 769560 01494 446790 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) Heritage Care Mrs Helen Brooks Care Home 48 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 48 older people, some of whom may have dementia, and/or a physical disability 25th January 2005 Date of last inspection Brief Description of the Service: Holmers House is a purpose built residential home, registered to provide care for up to 48 elderly persons within the category of old age and dementia type illness. The home is owned and managed by Heritage Care. Accommodation is provided in single rooms. The home is divided into smaller units, each with its own sitting room, dining room and kitchenette. There are safe accessible gardens to the rear and side of the property and car parking to the front. The home is situated in a residential area of High Wycombe, which has all the amenities of a large market town and has good commuter links. Public transport is accessible to the area. There are leisure facilities nearby and there is a large national department store and national chain supermarket in the same area as the home. Service users are registered with GP Practices and all service users have access to local NHS Services through GP referrals. Community Nurses visit the home and provide support to the home as needed. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection, which took place on the 14th September 2005. Care plans, medication records, recruitment files and other records were examined. Care practices were observed. The deputy manager and some of the staff who were on duty at the time were spoken to. Four service users were spoken to and their care plans were examined. What the service does well: The home provides a high standards of care to service users. The information provided, the pre-admission policies and procedures and the opportunity for trial visits work well, giving service users and their families the confidence that the home can meet their needs. In general service user’s healthcare needs are met. well and administered in a safe and timely way. Medication is managed There is a varied activities programme, although the vacant activity coordinator hours should be recruited to or used an imaginative way if the programme is meet more service user’s needs. Meals are well-balanced and meet service user’s nutritional needs. They are presented attractively and service users are encouraged to maintain their independence when eating. The complaints, and vulnerable adults policies and procedures work well and should protect service users. The staffing levels are good and the recruitment practices protect service users from unsuitable carers. What has improved since the last inspection? The medication trolleys are now stored away from direct heat and the temperature of the medication storage areas is now monitored. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 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. Holmers House DS0000022979.V250247.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 Holmers House DS0000022979.V250247.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): 1, 3 and 5 The statement of purpose and service user’s guide give service users and their families the information that they need to decide whether the home can meet their needs. The home’s pre-admission policies and procedures and the opportunity for a trial visit works well, giving service users, their families and staff the confidence that service user’s needs can be met. EVIDENCE: The home has a comprehensive statement of purpose and service user’s guide. This was available in the entrance hall on the day of the unannounced inspection. The deputy manager said that all residents are given a copy. The care plans of four residents were selected at random. All had comprehensive pre-assessment documentation. The deputy manager said that potential residents were visited at home or in hospital before they moved to the home. All residents have the opportunity to stay for a trial period before deciding whether they wish to move to the home on a permanent basis and a review is held at the end of the month with the service user, their family and the care manager if appropriate. The trial period can be extended if necessary. Holmers House DS0000022979.V250247.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 and 9 The care plans are not consistently completed and do not contain all the information necessary to meet service users needs. In general service user’s healthcare needs are met thereby maximising their health and well being. Service user’s weight is not monitored on a regular basis thereby putting them at risk that nutritional problems may go unrecognised and affect their health and well being. EVIDENCE: All service users had a care plan. Four were looked at in detail. The documentation in each varied and there did not appear to be a consistent set of documentation in each care plan. It is recommended that each care plan has an index and that a consistent set of documentation is agreed. All care plans seen had pre-assessments and personal care plans. Not all had photographs and missing person details. The daily entries were signed and dated. Not all care plans had been reviewed on a monthly basis and the deputy manager said that the normal practice was to evaluate care plans on a quarterly basis. It is recommended that this is undertaken monthly and is undertaken by a senior member of staff. In addition to the care plans used by the carers on a daily basis the senior carer in the unit maintains separate records of other significant events. On examination this record contained Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 10 information, which should also have been included in the care plan to guide carers in the daily care. It is recommended that the practice of maintaining two sets of documentation is reviewed and ways are found to ensure that they are either merged into one document or that the relevant information is in both. The service users seen and spoken to were well groomed and their personal care had been maintained. One service user said that the carers helped her to do as much as possible for herself. There were risk assessments in place including the risk of developing pressure damage. The deputy manager said that, following individual assessment, the local Primary Care Trust provides continence aids. There was little evidence of nutritional screening and none of the service users whose care plans were seen had been weighed. The carers said this was because they only had standing scales and that many of the service users could not be weighed without support. The organisation must purchase appropriate weighing scales and ensure that service users’ weight is monitored on a regular basis. Service users are registered with local General Practitioners and there was evidence in the care records that service users had seen the chiropodist, optician, physiotherapist and occupational therapist. There is a comprehensive medication policy. No service users self medicate at the moment although there are policies and procedures in place should a service users wish to do so. The home does not use homely remedies. Prepacked dosette systems are supplied by a local pharmacy. Records are kept of medication entering and leaving the home. The medication administration charts are completed accurately. Where medication is prescribed in addition to the regular medication, the carers hand write this medication onto the medication administration chart. It is recommended that two people sign the chart to say that it is a correct transcription from the original box in which the medication was dispensed. The deputy manager said that all carers who administer medication have a half day training course and that their competence is assessed by a senior carer before they give medication unsupervised. There was evidence that a pharmacist undertakes quarterly audits. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 11 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): 12, 13 and 15 There is an activities programme, which helps to bring interest and variety to the service user’s day. The home has an open visiting policy, which enables service users to maintain contact with family and friends. The meals are good, offering both choice and variety and catering for special needs. EVIDENCE: The home’s activity coordinator was interviewed. She described the work that she undertakes as a mixture of one to one activity, small group activities and some larger group activities. Shopping trips, blackberry picking, singing and quizzes are offered regularly. There is a weekly programme, which is tailored to the activities that people would like to do on the day. The home is funded for 25 hours of activity support although ten hours are currently vacant and this has limited the programme. There were good life histories in the care plans and service user’s interests were recorded. The service user’s guide states that visitors are welcome at any time. The service user’s spoken to confirmed this. Lunch was observed and the meal tasted. There is a four-weekly menu plan and service users have a choice of main meal. There are five portions of fruit or vegetables on the daily menu. A pureed version is available. The chef said that special diets could be provided. Service users were helped to maintain Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 12 their independence by the use of plate guards. Those who needed help were offered it discretely. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 13 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 and 18 The home has a satisfactory complaints system with some evidence that service user’s views are acted upon. Protection of vulnerable adults policies and procedures are in place and staff are trained to recognise abuse and the action to be taken, thereby protecting service users. EVIDENCE: There are complaints policies and procedures in place. A record is kept of complaints made and evidence was seen in the responses to complaints that they are taken seriously and that issues are addressed where necessary. There are protection of vulnerable people policies in place and the home has a copy of the Buckinghamshire Multi-Agency policy. The staff spoken to had received training in the protection of vulnerable people. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 14 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): These standards were not assessed at this inspection but were met at the previous inspection undertaken on the 25th January 2005 EVIDENCE: Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 15 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, 28 and 29 The staffing levels are good and meet service user’s needs. There is a need to maintain and increase the National Vocational Qualification programme if service users are to be confident that vocationally qualified staff is delivering their care. The recruitment policies and procedures generally work well and protect service users from unsuitable carers. EVIDENCE: The staffing levels are good and meet the recommendations of the residential forum and the Department of Health. A staffing rota is maintained. The deputy manager said that no staff are under 18 and that staff that are in charge of the home are over 21. Sufficient domestic and catering staff are employed. This was evidenced by the high quality meals and the cleanliness and lack of odours in the home. The manager holds the National Vocational Qualifications in Care and Management at Level 4 and the deputy manager is currently undertaking this award. Two carers are qualified to assess National Vocational Qualifications and five carers hold this award at level 2. A further 15 are registered to undertake the award at level 2 and four at level 3. This programme needs to be maintained and increased if the home is to meet the target that 50 of care staff hold the National Vocational Qualifications at level 2 or above by December 2005. The recruitment files of the last four people to be appointed were examined. All had application forms, interview notes, two references and a copy of the passport. Criminal Records Bureau checks had been undertaken before the Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 16 staff member started work. Not all had copies of birth certificates and a current photograph. This must be addressed. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 17 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): These standards were not assessed at this inspection. EVIDENCE: Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 18 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 19 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 7 Regulation 15 Requirement The care plans must be reviewed to ensure that he information needed by carers is in the care plans Care plans should be reviewed on a monthly basis by a senior carer. Appropriate weighing scales should be bought for use in the home. Service users weight should be monitored on a regular basis If it is necessary to transcribe medication details from the original box to the medication administration chart, two people should sign this. Staff recruitment files should hold a copy of the staff members birth certificate and a current photograph Timescale for action 31/01/06 2 3 4 5 7 8 8 9 15 12 12 13 31/01/06 31/12/05 31/03/06 31/12/05 6 29 19 31/12/15 Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 20 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 12 Good Practice Recommendations It is recommended that the vacant activities coordinator hours are filled or used in an imaginative way to increase the activities on offer in the home. Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 Holmers House DS0000022979.V250247.R01.S.doc Version 5.0 Page 22 - 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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