This inspection was carried out on 30th December 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.
CARE HOMES FOR OLDER PEOPLE
Holmesdale House 3 Holmesdale Road Bexhill-on-sea East Sussex TN39 3QE Lead Inspector
Lindy Latreille Unannounced Inspection 30th December 2005 09.10 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 Holmesdale House DS0000021362.V256930.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. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holmesdale House Address 3 Holmesdale Road Bexhill-on-sea East Sussex TN39 3QE 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) 01424 217953 Mr Elias Vidal Mrs Pamela Vidal Mrs Pamela Vidal Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is six (6) That the care home can provide residential care to older people aged sixty-five (65) years or over on admission. 3rd August 2005 Date of last inspection Brief Description of the Service: Holmesdale House is a detached family house situated in a residential road in the centre of Bexhill-on-Sea. The home is family run with resident owners and can cater for up to six older people. Holmesdale House is decorated to a high standard. There is a large attractive back garden with a sun terrace and several seating areas. Residents have their own bedroom with en suite lavatory and wash hand basin. Five of the bedrooms over look the back garden and there is level access to the garden. The bedrooms are light and well maintained and comfortable. Residents have the use of two lounges and a conservatory that is used for dining. The Registered Manager with her husband, son and daughterin-law provide the majority of care. This team is supported by a small group of carers. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second unannounced inspection that took place between 09.10 and 13.15. This report should be read in conjunction with the previous one for 03/08/2005 when nineteen (19) standards of the thirty eight (38) were assessed as met and three (3) were assessed to have minor shortfalls. All six of the residents were spoke to the Inspector in the lounge and each was offered the opportunity of a private interview but all declined. An interview was carried out with the Registered Manager and her husband (the proprietors), a tour of the premises was undertaken. Documentation read included; care plans, menus, minutes of staff meetings, health and safety checks and annual contracts and a staff personnel file. What the service does well: What has improved since the last inspection? What they could do better:
A stand-alone health care plan would ensure that all health needs were assessed and ongoing care could be monitored. A supervision programme should be organised. A quality assurance programme should be developed, and the Registered Manager, though experienced through nurse training, is not a qualified nurse and should achieve Registered Managers Award. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 6 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. Holmesdale House DS0000021362.V256930.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 Holmesdale House DS0000021362.V256930.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): 3. All prospective residents are assessed prior to admission and this assessment is recorded in the home. EVIDENCE: The Registered Manager visits all prospective residents in their own homes. On occasions she also takes the other carer. The residents have to be physically and mentally independent to fit the residents’ group already at the home, though prompting is frequently used to support independence. The preassessment enables the Registered Manager to draw up the care plans once residents are admitted to the home. Holmesdale House DS0000021362.V256930.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): 8, 9 and 10. Some health care is recorded in the care plan but this is not fully comprehensive and is difficult to monitor. Self-medicating residents are not all keeping their medicines locked in the secure place provided. All residents are treated with respect in all aspects of their care by all the staff. EVIDENCE: Some health care needs are documented in the care plan but not oral hygiene, tissue viability, psychological health, active falls management, all medical specialist services and necessary appointments. Without this information it is not possible to monitor the promotion of health for each resident. The residents felt that their health needs were being met and that they could discuss any concerns wit the Registered Manager at any time. The residents who are self-medicating sign an agreement as to how the safety of this procedure is managed within the home. One requirement is for the residents to ensure that the medication is stored in the locked facility provided in each bedroom. One of the residents finds it easier to keep the blister pack hanging on the wall of her ensuite. As none of the bedroom doors are locked
Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 10 this constitutes a health and safety risk to other residents. The agreement must be reviewed with the resident and a safe procedure put in place. The residents were vocal in their appreciation of the staff and the way that they were all cared for. One resident spoke of not feeling so well recently and the staff noticed that this, even though no mention had been made, and they made the appropriate intervention. Holmesdale House DS0000021362.V256930.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): 14 and 15. Residents have control in all aspects of their lives that for the majority supports their own independence. The menus and homemade food offered to the residents is varied and of a good quality. EVIDENCE: The residents said that they could exercise control and choice in all aspects of their lives with in the home. They spoke of their ability to get up each day when they chose and go to bed when it suited them. Some spoke of walks that they took daily with other residents and many spoke of their unlimited access to the garden. It was clear that outings were arranged sometimes and they went if they wanted to. The residents spoke most keenly about the high quality of the meals provided. At the recent residents’ meeting a discussion took place about some different meals and the residents said that even in so short a time their requests had been actioned. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 12 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): None assessed. EVIDENCE: Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 13 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): 21 and 23. All the residents’ bedrooms have ensuite facilities. The bedrooms are all on the ground floor and all but one open out onto the patio in the rear garden. EVIDENCE: All the bedrooms are sited on the ground floor. All the bedrooms have an ensuite lavatory and wash hand basin. All are light and well maintained. A French door opens out onto the patio in the rear garden for all but one bedroom, and there is a small step down onto the paving. Each room has a grab rail to assist exit. The residents spoke of feeling safe in their rooms and comfortable. Some of the residents have brought their own furnishings and the Proprietor confirmed that they encourage residents to bring what they would like so long as it will not cause a health and safety concern. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 14 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. There is no waking staff at night, though staff are employed to cover the waking night if a resident is unwell. The carer has now achieved National Vocational Qualification level 3 in Care. There has been no recent recruitment to the home but the Registered Manager is now aware of the procedures to follow. EVIDENCE: The Registered Manager confirmed that the home has never had waking night staff. All residents are able to use the call bell to alert the proprietors who live on the premises. When a resident is unwell an extra relief staff is employed to cover the night period. It is essential that a risk assessment is in place to justify this decision and is updated when a resident is unwell. The carer has completed her National Vocational Qualification level 3 in Care in September 2005 and this means that the home meets the 50 target for staff training. There has been no further recruitment to the home. The Registered Manager is now aware that positions must be advertised to comply with equal opportunities and all interviews conducted answer planned questions, to include gaps in employment, and that the process is documented and retained. All staff have a Criminal Records Bureau check and have been given the General Social Care Council (GSCC) code of conduct.
Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 15 Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 16 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): 33 and 36. There is no programme of quality monitoring in place. The Registered Manager has devised a pro forma for staff supervision but has yet to action a programme. EVIDENCE: There is no quality assurance programme in place but the Registered Manager confirmed that she is addressing this in her Registered Managers Award qualification and she feels confident that she will soon be able to develop a programme. Staff supervision has been carried out informally as in such a small home there is constant exchange of information. The Registered Manager has identified a suitable time when she can meet on a one to one basis with her staff and work through the agenda to meet the requirements of six times in the year.
Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 17 Holmesdale House DS0000021362.V256930.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X 3 X 3 X X x STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X x Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 19 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 2 3 4 Standard OP8 OP9 OP33 OP36 Regulation 12(1)(a) 13(2) 24(1)(a)( b) 18(2) Requirement That a holistic health care plan is devised for all residents. That the medication for selfmedicating residents is stored safely. That a quality assurance programme is devised. That a programme of staff supervision is commenced. (Previous timescale of 01/03/05 not met) Timescale for action 31/03/06 31/01/06 31/03/06 31/03/06 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 OP27 Good Practice Recommendations That the risk assessment is kept updated in respect of waking night staff. Holmesdale House DS0000021362.V256930.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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