Inspection on 02/08/07 for Holmewood Manor Care Home

This inspection was carried out on 2nd August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holmewood Manor Care Home 17/09/09

Holmewood Manor Care Home 05/08/08

Holmewood Manor Care Home 13/03/07

Holmewood Manor Care Home 25/07/06

Holmewood Manor Care Home 08/02/06

Holmewood Manor Care Home 19/10/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Holmewood Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH Lead Inspector Sue Richards Unannounced Inspection 2nd August 2007 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 Holmewood Manor Care Home DS0000064198.V340589.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. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmewood Manor Care Home Address Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH 01246 855678 01246 852953 tracy.robinson@hallmarkhealthcare.co.uk www.hallmarkhealthcare.co.uk Hallmark Healthcare (Holmewood) Ltd 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) *** Vacant *** Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old age, not falling into any other category Code OP The maximum number of service users who can be accommodated is 40. 13th March 2007 2. Date of last inspection Brief Description of the Service: Holmewood Manor care home provides personal care and support for up to 40 older persons. It is located off the main road in the village of Holmewood, near Chesterfield and close to Junction 29 of the M1 motorway. The home comprises of 34 single bedrooms, 22 of which have an en suite facility and three double bedrooms, all having an en suite. Single bedrooms without en suites have wash hand basins fitted. There is a choice of lounge and dining rooms to each floor, accessible by both stairs and a shaft lift. There are also a number of environmental adaptations and equipment provided to assist persons with physical disabilities. There is level access to very pleasant gardens, with areas provided for relaxation and stimulation, including seating and garden tables and also car parking spaces. Activities are organised on a regular basis, and details of these can be found in the entrance hallway, along with key information about the home, including a copies of our last key inspection report. Twenty-four hour staffing is provided from a team of care support and hotel services staff. Catering and laundry services are centralised, although there is a small laundry facility for service users who may wish to launder personal items. The registered manager post is currently vacant, although interim full time management arrangements are operational in the home on a full time basis. The range of fees is £325.05 - £343.20 per week excluding hairdressing, private chiropody, toiletries and newspapers, for which there are additional charges as per vendor. Information about fees is correct at the time of this inspection, as provided by the home’s administrator. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on all the information we hold about the service over the last 12 months. This includes the previous key inspection report of 13 March 2007, information provided by the home by way of a completed annual quality assurance assessment questionnaire, nine out of ten survey returns completed by or on behalf of people who live at the home and the unannounced site visit for the purposes of this inspection. Following our previous key inspection of this service we held a management review about the home and met with the registered provider to discuss our concerns about the poor management of the home and also set out our concerns in writing to them. We identified eight key areas where improvements were required. We told them what they must do to improve their service and when they must do it by. We asked them to provide us with an improvement plan for the home, telling us how they were going to make the necessary changes to comply with regulations and to improve outcomes for people who use the service. At this inspection, case tracking was used as part of the methodology. This involved the random sampling of three people whose care and service provision was examined more closely. Discussions were held with those service users (in accordance with their given capacities) and where possible their representatives and also the staff involved in their care. Individual’s care and associated records were examined and their private and communal accommodation inspected. At the time of this site/inspection visit, there were thirty people accommodated receiving personal care and support. What the service does well: People live in an environment, which well promotes their comfort, safety and wellbeing, including opportunities for their stimulation and relaxation and which suits their needs. On or before their admission, people are provided with a folder, which contains key information about the home and registered provider, including a service guide, and a copy of the last key inspection report. All of these are openly available and displayed in the reception area of the home along with photographs of the home, activities information and plaudits. People’s needs are assessed before they move into the home, which they are invited to visit and to join with meals, before choosing whether to live there. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 6 People’s health care and personal support needs are reasonably well met and they are well informed and about a range of recreational, social and spiritual activities, which they can access, both in and outside they home. They are also provided with a good standard of food, which accounts for their individual preferences and risk assessed needs. People are protected by the home’s recruitment practises What has improved since the last inspection? What they could do better: Ensure that people are provided with clear information within the service guide/brochure about fees charged and what they cover which accords with that required by regulation. Promote equal opportunity of access to information about the home and its services for people with sight difficulties by providing these in suitable alternative formats. Ensure that the implementation of the revised needs assessment and careplanning format for people is fully introduced by our extended timescale stated. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 7 Promote the effective use of menus and ensure that they always best inform people. Ensure that staff deployment arrangements are always planned in people’s best interests and that there are always sufficient numbers of care staff on duty as appropriate to people’s health and welfare. Sustain the key improvements made in the service and ensure that the home continues to effectively run in people’s best interests in ongoing consultation with them and their representatives. Secure appointment of a permanent manager for the home and ensure that any person who continues to manage the home applies for registration with the Commission by our extended timescale stated. 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. Holmewood Manor Care Home DS0000064198.V340589.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 Holmewood Manor Care Home DS0000064198.V340589.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): NMS 1 & 3. (NMS 6 does not apply to this service). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a range of information about the home and its services, although the service guide does not clearly informed about fees charged and the availability of all information in standard format only may not best promote equal opportunity for access for those with sight difficulties. The home’s phased implementation of their revised record keeping format for individual’s needs assessment (and care plans) should better promote individuals’ preferred daily living routines, choices and lifestyle preferences. EVIDENCE: At our last key inspection of this service in March (where we assessed NMS standard 3 only), we judged that people may be confident that the service would determine that their needs can be met before they move in. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 10 In our annual quality assurance questionnaire completed by the home, they said that they provide people with relevant information about the home before and on their admission and ensure that relevant assessment information is collated for each person including that obtained via local authority care management arrangements. They also said that people are usually invited to visit the home for varying intervals and to meet with people who live and work there. They said that over the last 12 months they have improved arrangements for admissions by ensuring a more smooth transition for people, including good communication. They would like for staff to become more involved in preadmission assessment and preparation for new admissions, which has previously been the domain of the most senior staff. At this inspection we spoke with people about the arrangements for their admission, including information provided for the about the home and its services and examined the same. We also spoke with them about their care needs and whether these were discussed and agreed with them and looked at their recorded individual needs assessment information. There were no people accommodated with diverse cultural needs. Information provided in the annual quality assurance assessment completed by the home detailed that there is a number of people with sight deficits. We received nine out of ten survey returns, which asked people whether they had received a contract and whether they were provided with enough information about the home before moving in to help them decide. Feedback from people was variable although mainly positive. The majority said they had a contract, including three people case tracked. Seven people surveyed said they were provided with sufficient information about the home prior to their admission. Two people surveyed felt they were not, although were not specific as to what information was lacking. Two people spoken with said they were not provided with clear information about fees from the home at the outset although had received some clarity through discussions since. People case tracked said they were able to visit the home prior to their admission. The home’s service guide/brochure was examined. This did not contain any information or specific details of fees charged, or what they include. This was discussed with management. The service guide is available in standard print format. One of the people case tracked was registered blind, who advised that their relative dealt with and advised them with regard to written information provided by the home. There were other people living at the home with sight difficulties. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 11 Recorded needs assessment information was in place for each person case tracked, including relevant pre-admission assessment and care planning information. These were reasonably well recorded, although were lacking in the provision of individual’s choices with regard to their daily living and lifestyle preferences. This was discussed with management, who advised that they were in the process of addressing this by the introduction of a revised needs assessment and care-planning format. This was being introduced via a revised key worker system with staged implementation by way of individual staff training. Examples of those already transferred and completed were provided. These were comprehensive and person centred and staff was conversant with their content. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 12 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): NMS 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health care and personal support needs are reasonably well met in a more sensitive manner. The home’s drive to improve its systems and approaches to individuals’ care has already resulted in areas of notable and key improvement, which, if fully implemented and sustained may better ensure that people’s needs are always met in a manner of sensitivity and respect. EVIDENCE: At our last key inspection of this service we judged that plans of care demonstrate that residents’ health and personal care needs are considered, although are not kept up to date and that there are insufficient records to demonstrate how their social needs are met. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 13 We said that people’s care plans must be developed and kept up to date in consultation with them and that records should fully reflect the needs of residents and detail clear holistic care interventions. We also said that medication record systems did not fully protect the residents. And said that they must improve their record keeping practises with regard to the administration of people’s medicines. Our pharmacist inspector also carried out a random inspection to the home on 12 June 2006 who identified that the above were not fully complied with. We also said at that visit that the home must ensure the proper storage of some medicines and that they should ensure that hand written medicines instructions are properly recorded. In our annual quality assurance assessment questionnaire completed by the home they said that they are driving to improve approaches to care planning and risk assessment and staff approaches with people and towards their care. They also said they that there are measured improvements in medicines management and administration by way of staff training and close management monitoring. They identified that in terms of developing care planning and a positive staff culture, attitude and approaches to individual’s care, that there are already marked improvements. At this inspection we spoke with people and their representatives as available, about the care they receive and inspected the written care plans and associated health care records of people case tracked. We also spoke with staff about the arrangements for care delivery and with a district nurse who regularly visits the home. We also asked people by way of written surveys whether they receive the care and support they need; whether staff listen and act on what they say and whether they receive the medical support they need. The majority of people said they usually received the care and support they needed, although some comments were made that there were not always sufficient staff available. (See staffing section of this report). They also said that most staff is usually respectful towards them and most said they always receive the medical support they needed, although two said that they sometimes did. One of the latter clarified by saying that they felt this was to do with staff availability and the fact that some care staff are more responsive than others. Feedback from the district nurse was very positive who felt that improvements were made with good support and liaison currently provided by the home in respect of the people she provided nursing care inputs for. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 14 Written care plans for people case tracked, contained basic information, although there were omissions in recording for individual’s risk assessments and reviews. The care plans for people case tracked were not person centred or reflective of people’s individual daily living choices and lifestyle preferences and did not always detail clear holistic care interventions. However, care plans were also examined, which were recorded in accordance with the revised care planning system being introduced by management. These were well recorded and were person centred, holistic and up to date, with people’s signed agreement to those care plans. We therefore agreed an extended timescale with management to ensure that all care plans are recorded in this manner. The arrangements for the management and administration of medicines were examined via case tracking and also to assess compliance and progress with previous requirements and recommendations made by the Commission’s pharmacist inspector. These were clearly improved and all previous requirements made are complied with. However, people’s ability and choice to look after their own medicines was still not recorded in the assessment information for those people case tracked. During discussions with them they advised that they preferred staff to retain and assist them with their medicines. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well informed and provided with a range of activities, which usually accord their people’s choices and preferences People are provided with a good standard of food, which accounts for their individual preferences and risk assessed needs. EVIDENCE: At our last key inspection of this service we judged that a range of activities, a welcome to visitors and catering arrangements ensure that residents’ preferences are considered. However, we made a recommendation that daily menus should be provided for residents (in suitable formats) and detail the full choice of menu offered about which residents should be openly consulted and enabled to make an independent choice. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 16 In our annual quality assurance assessment questionnaire completed by the home they said that they always provide a range of activities for people to choose from both within and outside the home, welcome visitors and offer varied and good quality food. They also said that although they have begun to improve and ascertain a more person centred approach to people’s care and support in terms of their daily living arrangements that further improvements are intended over the next twelve months, including promoting more choices for people in their daily lives and also with regard to the quality of food. At this inspection we spoke with people about their daily living arrangements and social activities available to them. We examined information provided for people about these and also records kept with regard to individual’s daily living choices and engagement in activities for those people case tracked. We asked people by way of our written surveys whether activities are arranged in the home, which they can take part in and whether they like the meals at the home. With regard to activities, four people said they usually were and five said sometimes. Two people said that they were often not appropriate to their needs and felt that their sight and physical disabilities impacted on this. One of those said that they didn’t go into the main lounge, but stayed in their room because it was noisy and difficult for them due to their disabilities. However, they said they were provided some choice of activities, including outside the home. In respect of meals, three said they always like the meals at the home and six said they usually did. People spoken with during the inspection and records and information examined indicated that a range of activities are provided, both in and outside the home, and that seasonal celebrations and entertainment are always organised. People expressed considerable pleasure with the recent development of the garden area, which some described as ‘spectacular’ and a ‘real pleasure’ for us. They advised of a planned garden party to be held to formally ‘open’ the garden with plans for a fish and chip supper. Others spoke about links with the local churches and their regular visits to church and coffee mornings. All said that their visitors were always made welcome and are offered drinks and invited to stay for a meal. As stated under the Healthcare section of this report, individuals’ care plans and associated care records examined did not always give a good account of people’s individual choices with regard to their daily living routines and lifestyle preferences, although the revised care planning format being introduced gave greater account of these. However, people spoken with said that there are positive changes in staff routines to better accommodate their personal choices with regard to their own daily routines and preferences. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 17 At the time of this inspection the activities co-ordinator was attending training outside the home. All spoken with said that they enjoy their meals, which they felt had improved with regard to quantity and availability given recent concerns/complaints made regarding meals (see Complaints section of this report). A single printed menu in standard format was available in the dining room, detailing a choice of food, although it was in a covered folder placed on the sideboard. People sitting at dining tables waiting for lunch to be served said they did not know what was for lunch until staff served this. They said there was always an alternative for them to choose from for each course at each meal. The meal(s) served at lunchtime did not match those stated on the menu. They were variations of a theme, for example sausage and mash was in fact sausage and new potatoes and the alternative, being cheese quiche and salad was actually cauliflower cheese. Food was well presented, tables were attractively set and staff assisted people as required in a sensitive manner. We are advised since the inspection that menus are now being created and agreed by the clients. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and handling of complaints by the home and its systems and arrangements for the safeguarding of people from abuse and harm provides good assurance that their best interests and safety is being effectively promoted and protected. EVIDENCE: At our last key inspection of this service we judged that there was a satisfactory complaints procedure, but safeguarding adults guidance did not ensure that residents were be fully protected. We said that care staff must have proper information provided for them and be made aware of the processes to report any suspicions of abuse. We also said that staff should attend local authority training on safeguarding adults. In our annual quality assurance assessment questionnaire completed by the home they said that complaints are documented and procedures followed to ensure that any complaint is investigated and dealt with appropriately. They also said that the improvements they have made have resulted in people being more comfortable about making complaints and expressing their concerns and to ensure that allegations of abuse are dealt with immediately and robustly. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 19 At this inspection we spoke with people about how they would complain or raise concerns if necessary and their confidence regarding the home’s ability to respond and act in their best interests. We also examined the home’s complaints records, discussed the management of these with management and also spoke with staff about their responsibilities with regard to dealing with complaints or concerns and allegations. People said they were knew how to complain, including all of those people who responded by way of our survey returns and some people said that they are more confident to complain and felt that management take them seriously and act on what they say. Staff spoken with were conversant with their responsibilities and had received training with regard to recognising abuse and responding and reporting to allegations, suspicion or witnessed abuse. A rolling programme of training was instigated with regard to this, with the majority of staff having attended and a further session organised. Also relevant policy and procedural guidance is in place, which they can access. Since the previous key inspection of this service there has been eight complaints and two allegations made to the home. Of the allegations, one alleged bullying and rudeness by a named staff member towards people living the home. The other alleged verbal abuse of a resident by a named staff member. In both instances management took immediate and necessary action to ensure the safety of people who live at the home, including the reporting of these to the appropriate professional bodies. Both of these allegations are fully investigated by the home via recognised joint agency safeguarding adults’ procedures, which have concluded that action taken by the home is satisfactory. Complaints made include, four regarding of food/drinks for people alleging lack of choice, availability and quantity. These were upheld by the home and they have taken action to improve these, with management arrangements in place for the ongoing monitoring of these. One complaint was made about laundry not being undertaken in a timely manner. This was partially upheld by the home and their complaints record detail action taken, including satisfactory resolution of this with the complainant. Two complaints made concerned monies and additional charges. The first related to an allegation of missing monies belonging to a resident, which was not accounted for/missing on their admission. Complaints records kept by the home indicate that agreement is made with the complainant regarding future handling and safekeeping arrangements to their satisfaction. The second is with regard to a daily newspaper being ordered twice on behalf of the same Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 20 resident, resulting in them being billed twice for the same newspapers. The home’s complaints records detail that apologies were made and monies refunded by them to that person, and which is resolved. The final complaint was with regard to staffs’ care of a resident’s oxygen humidifier and failure to ensure changes of water in the humidifier. The home’s complaints records indicate that staff have received instruction and are now required to maintain a record of water changes, which is kept in that person’s room. Records indicate that this is resolved to the satisfaction of the complainant. . Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 21 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): 19, 24 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The environment well promotes people’s comfort, safety and wellbeing, including opportunities for their stimulation and relaxation and suits their needs. EVIDENCE: At our last key inspection of this service we judged that the home is furnished, cleaned and maintained to a good standard, providing residents with a pleasant and comfortable place to live. We said they must provide us with evidence and details of the action taken to ensure the satisfactory maintenance of the hot and cold water systems in the home to prevent the risk of Legionella. This was provided following that inspection and is satisfactory. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 22 In our annual quality assurance assessment questionnaire completed by the home they said that the home is safely and properly maintained and is clean, tidy and odour free. They had identified to improve the ‘homeliness’ feel for people and to continue with ongoing repair and renewal over the coming twelve months. They also said that they had upgraded the garden areas to ensure that it is attractive and safe for people to use. At this inspection we visited the private and communal areas accessed by those people case tracked. We also asked people in our surveys if they felt the home is always fresh and clean. All areas seen were safe, comfortable and clean, odour free and well decorated and personalised. People said they were very satisfied with their environment and those surveyed all said that the home is always kept fresh and clean, except one person, who said it sometimes is. The range and choice of lounge and dining space was seen as very positive by the majority of people, who said they could choose given their need for stimulation or quieter space. The garden area has been totally redeveloped since the previous inspection providing a variety of planting and seating areas, which are very pleasant and attractive, providing opportunity for stimulation or relaxation. One man spoke of the interest and pleasure he gets from the garden, which he participated in growing and tending, including a raised vegetable patch. People expressed pleasure and satisfaction about the garden and were looking forward to its official opening the following day by way of a garden party and fish chip supper. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 23 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are protected by the homes’ recruitment practises and the improvements in staff induction and training arrangements (including record keeping) are clearly in people’s best interests. However, staff deployment arrangements may not always be consistently so. EVIDENCE: At our last key inspection of this service we judged that induction and training procedures for staff were not well demonstrated so that resident’s protection was not fully assured. We said they must keep records of induction and ongoing training for individual members of staff to demonstrate that appropriately trained staff is providing care for the residents. We also said that staff should have individual training and development assessments and profiles that include up to date records of training. In our annual quality assurance assessment questionnaire completed by the home they said that they have improved staffing arrangements by way of their effective recruitment and selection, training and deployment. Their plans over the next twelve months are to continue their improvements, particularly with Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 24 regard to ongoing training and with focus ensuring further training in safe guarding adults’ procedures, medication and fire training. At this inspection we spoke with people about staff availability and our preinspection surveys also asked people if staff were available when they needed them. We spoke with staff about the arrangements for their recruitment, induction, training and deployment and examined associated records, including the personal records for four of the most recent staff starters. The majority of people spoken with and surveyed said that staff is usually available, although sometimes are very busy resulting in them having to wait for longer periods than usual. At the time of the inspection there were thirtythree people accommodated. Discussions were held with management and staff about dependencies, which overall were said to be fairly low, although there was no formal assessment process to determine people’s dependency levels. During the afternoon of the inspection people were complaining that mid afternoon drinks were already 30 minutes late. At that time there were three care staff on duty and thirty-three residents between 2.30 pm and until 4pm when an additional care staff was provided. Care staff spoken said there is usually four staff throughout the day but there had been three on that day due to staff training and sickness, although said that staff sickness sometimes affects total numbers deployed when it occurs. This was discussed with management. During the inspection we visited the first floor lounge on a number of occasions during the day. There was no staff member supervising the first floor lounge. One resident case tracked fell in that lounge area during the morning. This accident was not witnessed. Their needs assessment and care planning information identified a significant risk of falls for that person who also demonstrated some confusion during discussions with them. Information provided on the annual quality assurance questionnaire from completed by the home stated that they provide a total of 579 care staff hours per week. Assuming that all thirty-three people accommodated are of low dependency, guidance from the Residential Forum, which calculates recommended care staff hours, indicates that a total of 712.23 care staff hours should be provided per week. This includes manpower planning for 20.88 hours for social, recreational and cultural activities, 11.59 hours for staff training and 152.36 hours for staff overheads (sickness, holidays etc). This indicates that staff deployment does not properly account for staff overheads. Staff personal files examined contained all satisfactory information with regard to their recruitment, employment, induction and training. A comprehensive induction programme was introduced for care staff in accordance with Skills for Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 25 Care common and foundation induction standards. All new staff starters were commenced via this programme and all existing staff is to undertake this via a planned rollout, which had commenced and for which it is aimed for all staff to have completed by November 2007. A training matrix and staff training plan was also in place, which was examined. This detailed the recognised range of common core health and safety training through to NVQs and additional training, including recognised dementia care and care planning and accountability for all staff. This was progressing well. Six care staff had achieved at least NVQ level 2, including one with a level 3 (approx 33 of staff). A further three were in process of doing NVQ level 3 and eight NVQ level 2 (approximately 66 ). Arrangements were also in place for further hotel services staff to undertaken NVQs. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 26 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): NMS 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The deployment of good interim management arrangements has resulted in key improvements in the service, which if permanently and suitably secured should ensure that the home continues to run in their best interests. EVIDENCE: At our last key inspection of this service in March 2006 we judged that the home is not being effectively managed to ensure residents’ health, safety and welfare and the quality outcome in this area was assessed as poor. There has been no registered manager in the home since 31 July 2006, with a series of acting managers in post. We said that a manager must be appointed to the Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 27 home with an application then submitted to the Commission for registration for their manager by 30 June 2007. We also said that a formal system must be established and maintained for reviewing at appropriate intervals and improving the quality of care provided at the home, which includes consultation with residents and their representatives. Following our inspection we held a management review about the home. Following this we met with the registered provider to discuss our concerns about the poor management of the service and also set out our concerns in writing to them, identifying eight key areas where regulations were being continuously breached. We told them what they must do to improve the service and when they must do it by and asked them to provide us with an improvement plan for the home telling us how they are going to make the necessary changes to comply with the regulations and to improve outcomes for people who use the service. In our annual quality assurance assessment questionnaire completed by the home, in terms of what they do well, they said that they encourage people where possible to manage their own monies with safekeeping facilities provided. They said have made significant improvements in the home by way of introducing formal quality assurance and monitoring systems, which include consultation with people about the home and its services. That they have put in place a project manager who has addressed the majority of requirements from the last key inspection report, introduced individual staff supervision and that six of the eight improvement areas we identified are complied with. They also said they are in the process of recruiting a registered manager for the home. At this inspection we spoke with the project manager about the previous requirements and areas of improvement identified by them, examined relevant records and spoke with staff and people who use the service. Out of the eight key improvement areas, six are complied with and two partially complied with. One of the latter is with regard to care planning, which work had commenced and is therefore partially achieved. We have therefore agreed to an extended timescale to complete this work. With regard to appointment of a manager for the home, they immediately secured a project manager who has worked hard to achieve management stability in the home. During this time they have advertised and sought to recruit a suitable (registered manager). Information provided at this inspection is that a suitable candidate was recently selected, who withdrew from offer of appointment. However, further interviews are planned with a view to imminent appointment to this post. We have therefore agreed to an extended timescale for appointment of a registered manager to account for the recruitment process. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 28 Staff spoken with was conversant with their roles and responsibilities and also those of others and including with regard to ensuring safe working practises. All areas of the home inspected were safe and free from hazards and details of maintenance arrangements were also provided. The arrangements for the management and handling of people’s monies were examined via case tracking and are satisfactory and in accordance with information provided by the home in our annual quality assurance questionnaire. Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 29 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 X 3 3 X 3 Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5 (amended 2006) Requirement Timescale for action 30/09/07 2. OP7 15(2) 3. OP27 18(a) 4. OP31 8,CSA Details of the total fee payable in respect of services provided, including any additional charges to that fee and the arrangements for their payment must be provided within the service user guide, together with a statement as to whether any matters would be different in circumstances where a person’s care is funded, in whole or part by a person other than them. Those care plans, which have not 30/09/07 been revised, as identified at this inspection, must be developed and kept up to date following consultation with the individual residents/or their representative (if unable) so that records fully reflect their needs (and detail clear holistic care interventions). (Original timescale 30/04/07) At all times there must be 31/08/07 sufficient numbers of care staff working at the home as appropriate for the health and welfare of the people who live there. A manager must be appointed to 30/09/07 DS0000064198.V340589.R01.S.doc Version 5.2 Holmewood Manor Care Home Page 31 (11) the home with an application then submitted to the Commission for registration of that manager. In the absence of such an appointment, should the project manager continue to manage home they must submit an application to the Commission for their registration. (Original timescale 30/06/07 – extended timescale agreed at his inspection). 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 Key information about the home, including its service guide should be available in alternative formats to suit people’s needs, such as large print or audiotape format to assist those who may have considerable sight deficits, or who may be registered blind. People’s ability and choice to look after and manage their own medicines should be assessed on admission to the home so that their choices, preferences are taken into consideration and should be clearly recorded within their needs assessment information and regularly reviewed with that person. A recognised dependency assessment tool should be introduced and recorded for each person accommodated, which is regularly reviewed and which may be used to inform staff planning and deployment arrangements. 2. OP9 3. OP27 Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Holmewood Manor Care Home DS0000064198.V340589.R01.S.doc Version 5.2 Page 33 - 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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