Inspection on 27/04/05 for Holmes House Care Home

This inspection was carried out on 27th April 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

Holmes House Care Home 08/11/06

Holmes House Care Home 07/02/06

Holmes House Care Home 25/10/04

Holmes House Care Home 18/05/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Holmes House Kenilworth Road South Wigston Leicester LE18 4UF Lead Inspector Bhavna Keane-Rao Unannounced 27 April 2005 9:10am 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 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. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Holmes House Care Home Address Kenilworth Road South Wigston Leicestershire LE18 4UF 0116 2782214 0116 2789379 holmeshousecare@aol.com Collegia Care Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Linda Georgina Warren Care Home 48 Category(ies) of DE(E) Dementia - over 65 (25) registration, with number of places MD Mental Disorder (6) LD Learning disability (4) PD Physical disability (10) SI Sensory Impairment (4) OP Old age (48) Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No person falling within category DE(E) may be admitted to the home when 25 persons who fall within category DE(E) are already accommodated within the home. No person falling within category MD(E) may be admitted to the home when 6 persons who fall within category MD(E) are already accommodated within the home. No person falling within category LD(E) may be admitted to the home when 4 persons who fall within category LD(E) are already accommodated within the home. No person falling within category PD(E) may be admitted to the home when 10 persons who fall within category PD(E) are already accommodated within the home. No person falling within category SI(E) may be admitted to the home when 4 persons who fall within category SI(E) are already accommodated within the home. Date of last inspection 25/10/04 Brief Description of the Service: Holmes House Care Home is a care home offering accommodation for up to forty eight older people (over 65). The needs of people choosing to move to the home range between physical disabilities, mental disorders, dementia, sensory impairment and learning disabilities. The home is owned and managed by Collegia Care Limited. The home is located in South Wigston which is approximately fifteen minutes by car from the Motorway (M1 and M69 junction). It is situated five minutes by car from the main high street in South Wigston which has a range of local shops and facilities. The building itself is a modern purpose built property set in substantial grounds. The immediate area is a residential area. All areas of the home are accessible for people with mobility limitations and the home is equipped with a slow moving lift. The surrounding grounds are well maintained with level pavements throughout. Parking is available to the front of the property. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during Tuesday morning and early afternoon. A number of residents were spoken with, but detailed discussions were only held with four of them. Three residents relatives were also spoken with. A tour of the premises was undertaken and opportunity was taken to view residents daily records, menus of meals, fire records, accidents book, staff communication book, a staff rota and staff records. The registered manager, who spent time discussing many issues that arise in the running of a residential home, facilitated this inspection. What the service does well: What has improved since the last inspection? Eighteen bedrooms have now got upgraded electrics. A number of policies and procedures have now been developed since the last inspection that, if used correctly, will reduce the concerns identified at this inspection. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 6 All the staff at the home have now commenced their National Vocational Qualification level 2 training. The senior person has commenced her NVQ level 3. The registered manager has commenced her NVQ level 4. 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. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 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 standard(s) 2,3,5 and 6 Information about the home is provided from the earliest opportunity and at regular intervals. The admission process is well managed and reflected in the records. Resident entering the home are always assessed so that their needs can be met. EVIDENCE: Examination of the Statement of Purpose indicated that the document accurately describes the services provided in the home. The admission procedure is adequate in that assessments of individuals are carried out by health and/or social care professionals, as part of the referral process. Four service user files were viewed they detailed the specific care needs of service users, identifying the needs that would be met by heath and/or social care professionals. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 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 standard(s) 7,8,9 and 10 Residents’ health care needs are not met. The number of falls and pressure sores are unsatisfactory indicating a lack of risk assessments and oversights in the provision of care. Management of medication in the home is not satisfactory and so must be reviewed. The guidance on administration of medication procedure is not followed. Residents’ privacy is upheld and they are treated with respect. EVIDENCE: Recording in the residents’ plans of care and daily records were viewed and showed the following areas of concerns: • The daily entries are very brief • Areas of concerns highlighted by one shift have not been followed by the next shifts. • Care plans are not signed by anyone ie staff or the residents. • Care plans are not used to provide appropriate care to residents e.g. where a residents diet is noted as to be monitored in the care plan, it not mentioned thereafter in any records. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 10 • • No risk assessments on any areas of identified concerns. Areas of concerns with regard to falls are not followed up in the care plans. Medication is stored in locked medical trolleys in the treatment room and administered by staff that are trained. Administration of medication and recording was seen and is considered to be unsafe. On a number of occasions it was noted that on the MAR sheets ‘o’ has been inserted after they had been signed. Discussion was held with the registered manager as this indicates that staff are actually signing records prior to giving out the medication. Another area of concern was that ‘o’ is used as per the key symbols at the bottom of the MAR sheets. However no further explanation is given, against the home’s own administration of medication guidance. Records showed that staff have been trained by the district nurse to give out insulin injections. Discussion was held with the visiting district nurse who stated that staff were very good at following instruction. However there had been an increase in falls and the number of pressure sores was also an area of concern. This, she stated, could be due to residents not being moved and so leading to sore areas. Observations in the lounge and the dining areas showed that staff have a good awareness of how to speak with residents with curtsey and kindness. All the residents are on electoral register and have now received their voting cards for the forthcoming elections. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 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 standard(s) 12,13,14 and 15 Residents’ religious preferences are catered for. Residents’ relatives are happy with the choice and input that they are given in the provision of care. There is activities person who is employed to ensure residents are given stimulation and their recreational needs are met. Residents are provided with a choice of meals at all meal times. EVIDENCE: A religious service is provided in the home once a month and is utilised by residents of different faiths. The manager has employed an activities person who works 20 hours per week. The activities person undertakes a range of activities with services users ranging from reading, internal library service, making range of things, to painting. The activities list on resident’s notice board keeps residents up to date about the types of events planned during the week. Several family and friends of residents confirmed the presentation of meals was good. The staff members were seen as approachable and willing to listen to any concerns. Overall they felt the level of care was good. One resident stated that the vegetables were frozen and never fresh. The manager stated that this was correct but that this did not take away any nutritious value of the food. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 12 Meals provided are prepared and cooked on daily basis. Special diets are catered for. When residents are unwell an alternative meal is provided. Residents spoke with confirmed a choice of meals was available and the food was good. A resident stated that she enjoyed weekend roast the best. She also stated that she enjoyed her breakfast, as it was a choice of fully cooked or continental style. Residents are consulted about their clothes, daily pursuits, and refreshments and meal choice. A service user with limited communication was observed being offered a meal choice and making her decision known. A member of staff was observed having a light hearted banter with residents to enable them to relax while being taken to provide personal care more discreetly. This was very positive interpersonal skill and the manager was informed about this particular member of staff. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 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 standard(s) 16 and 18 Residents are confident in discussing any issues of concerns with the staff or the manager before it leads to a complaint. Although there are policies and procedures in place for protecting adults, these must be reviewed as the staff are not aware of them and so can lead to residents being left vulnerable and at risk. EVIDENCE: Residents spoken with were aware of the fact that they could go to staff with they had any concerns. There has been one complaint received by the Commission for Social Care Inspection since the last inspection. This was being investigated on the day of the inspection. Regarding moth larvae found in the kitchen and the number of falls in the home leading to bruising. Environmental Health Officer have visited the home and recommendations have been made. On the day of the inspection residents who were spoken with did not have bruising. However the high level of falls is being dealt with in conjunction with other health care professionals. A senior member of staff who was spoken with in detail was not aware of the recording of the home’s Complaints Procedure or of the Vulnerable Adults Procedure. These are very important procedures to follow to safeguard residents from abuse. Subsequent to the inspection the providers have informed CSCI that training was provided for ten members of staff on POVA on 28th April 2005. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 14 Two residents and their relatives who were spoken with in detail stated that any time they raise any issues of concerns these are acted upon. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 15 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 standard(s) 19,20,21,22,23,24,25 and 26 There have been improvements to the bedrooms being upgraded since the last inspection. There has been an improvement to the cleanliness within the home this is evident in some areas upstairs. However this judgment was not found to be true downstairs and upon immediate entry into the home. The home provides specific equipment for residents which meets their needs. EVIDENCE: There has been improvement to the upgrading electric in the home, 18 bedrooms since the last inspection. However this is not yet finished. The downstairs of the home will be done after the upstairs is totally finished. The manager stated that there has been an improvement to the cleanliness within the home, however this was not obvious as there was strong smell of urine in a number of areas within the home. As soon as you enter the home there is a strong offensive smell that greets you. This was explained to the manager who stated “a year ago the smell used to greet you upon entering the gates. So there has been an improvement.” Discussion was held with the Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 16 manager as this reflects badly on the home since the first impression that a person will get is the strong smells. This was acknowledged to be a problem, which needs attention. One resident’s bedroom was viewed and it was noted with concern that this person was in their room and the commode had not been emptied. This was at 11.30am. During the tour of the home it was noted that there were jugs of water and juice left in all the communal for residents to have when they want. This is a very good working practice. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There is a staff training programme in place to ensure staff are trained and competent to do their job safely. However this is not enabling the staff to provide care in a safe manner in all instances. There is a robust recruitment procedure which will ensure appropriate staff are employed by the home. EVIDENCE: Staffing rotas were examined and it was noted that agency staff are regularly used, to cover sickness and absence, to meet the needs of the residents. The following areas of concerns were raised on the day of the inspection: • A new member of staff was observed about to hoist a resident. She had not been provided with training and was on to shadow experienced members of staff. There were other staff in the area. The manager was informed of this situation who immediately dealt with it. • A senior member of staff had not been trained with regards to Vulnerable Adults Procedure. She is left in charge of other care staff. • The communication books has records of continence pads being inappropriately disposed. • The communication book has records that talcum powder is used in the incontinence pads. • The communication book has records that residents are not sat appropriately on modular cushions. Residents’ relatives confirmed that each resident has a key worker who will respond to their relatives needs on time and know how to assist them. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 18 Comments received from residents: “They are good girls” and “They (Staff) are kind”. On the day of this visit in addition to the manger on duty there were five care staff and one senior on duty. There was also a cook, breakfast assistant, activities person, the administrator, maintenance person, a laundry person and three cleaning staff. Training is planned offering a range of courses and refresher training ranging from mandatory training to National Vocational Training. Three staff training files looked at during the inspection visit showed that training was made available to all staff on a regular basis, which includes moving and handling, first aid and food hygiene. All relevant paper work was also available. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37 and 38 The fact that there is persistent offensive odour in the home, a high level of falls of residents and lack of staff awareness of procedures has shown a weakness in the way that this home is managed. The health, safety and welfare of resident are compromised at this home. The procedure to manage residents finance is not followed. EVIDENCE: The staff members spoken with felt supported by the manager and that there were procedures in place to voice any concerns that they may have. There are regular staff meetings, supervision and residents meetings to enable the manager to monitor what is happening at the home. However, there is a breakdown in communication as staff are not following the policies and procedures such are care plans being reviewed as and when the residents care needs change, giving out of medication safely, moving and handling and managing incontinence. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 20 All the staff are not provided with training on Vulnerable Adults Procedure. While it is important for all staff it is critical for senior staff to be familiar with this procedure. The resident’s finance records were viewed and it was noticed with concern that two members of staff were not signing these records. The manager stated that she was aware of the correct procedure and that is would not have been an issue had this not been an unannounced inspection. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 2 x 1 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 3 2 2 2 3 3 3 2 Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 22 No 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 7 Regulation 12,13,15 Requirement It is required that daily records reflect the provision of care for residents. In particular any significant event must be recorded along with the action taken. It is required that the staff must follow up any areas of concerns highlighted by those on previous shifts. This must be recorded. It is required that care plans are reviewed and up dated as and when the care needs of residents changed. It is required that care plans are used by staff on the provision of care for the residents. It is required that risk assessments are carried out on all identified areas of concern. It is required that all falls are monitored and risk assessments are carried out to minimise these. It is required that Medication Administration Sheets are only signed after medication is given out on individual basis. As per the homes’ Safe Handling of Medication guidance. It is required that correct key Timescale for action Immediate 2. 7 12 Immediate 3. 7 15 Immediate 4. 5. 6. 7 8 8 13,15 13 13 Immediate Immediate Immediate 7. 9 13 Immediate 8. 9 13 Immediate Page 23 Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 9. 18 18 10. 11. 19 26 23 16 12. 13. 14. 26 28 28 12,16 13,18 13,18 15. 30 16 16. 30 12,18 17. 32 9,12,18 18. 33 18 19. 35 17 symbols are used when signing the MAR sheets. As per the homes’ Safe Handling of Medication guidance. It is required that all members of staff are given training on the procedures to be followed when allegation of abuse is made ie the Mistreatment of Vulnerable Adults procedure. It is required that the programme of refurbishment is continued throughout the home. It is required that problem of offensive odour in a number of areas within the home is dealt with. It is required that commodes are emptied on a regular basis. It is required that all new staff are told not to use the hoist until training has been provided. It is required that all staff members are given a refresher training on Moving and Handling. It is required that all staff members are given new instruction on disposing of continence pads. It is required that all staff members are given instructions on how to use pressure sore aids correctly. It is required that the registered manager has a staff meeting to reiterate what the philosophy of care within the home are. It is required that all the members of staff follow procedures that are in place to safe guard and protect residents health and welfare. It is required that when dealing with residents finance two people sign the records every time there is a transaction 31/05/05 On going Immediate Immediate Immediate 31/05/05 31/05/05 Immediate 31/05/05 31/05/05 Immediate Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 24 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 15 Good Practice Recommendations The registered providers are recommended to include fresh vegetables in the provision of wholesome appealing balanced diet. Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 25 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park, Enderby Leicester, LE19 1SX 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 Holmes House C51 S58967 Holmes House V223971 270405.doc Version 1.30 Page 26 - 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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