Inspection on 05/08/08 for Holmewood Manor Care Home

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Adequate service.

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

Holmewood Manor Care Home 17/09/09

Holmewood Manor Care Home 02/08/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Holmewood Manor Care Home Barnfield Close Holmewood Chesterfield Derbyshire S42 5RH Lead Inspector Susan Richards Unannounced Inspection 5th August 2008 09:00 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.V370167.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.V370167.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 holmewood@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.V370167.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. 2nd August 2007 2. Date of last inspection Brief Description of the Service: Holmewood Manor care home provides accommodation, 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 there is an acting manager in post with external management support provided. The range of fees is £336.42 to £355.21 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.V370167.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous unannounced key inspection report of 14 August 2007 a report of our random unannounced visit of the home on 28 January 2008 and our annual quality assurance assessment questionnaire (AQAA), which we asked the home to complete in order to provide us with key information about the service. At this inspection there were twenty-nine people accommodated. We used case tracking as part of our methodology, where we looked more closely at the care and services that three of those people receive. We did this by talking with them, direct observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We also employed an Expert by Experience who accompanied us on our inspection visit to the home. Our expert spent approximately three hours at the home between 11:00 and 14:00 hrs. We asked them to talk with people and make general observations about their lifestyle experiences at the home, including as to how their rights to be treated with respect, their dignity, privacy, choice and independence is promoted. The expert chose to focus their visit around meals and activities. We also received completed survey returns from ten people who use the service and five staff employed there. At our visit we spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the acting manager and the administrator about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). We received a number of comments from people who use the service. These included: Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 6 ‘I was determined to come to the Manor because I used to come for day care and decided I would come here full time.’ ‘Before I lived here, my husband already lived here for approximately 1 year. Very pleased with the home.’ ‘The quality of food is good.’ ‘Staff are brilliant and look after me well.’ What the service does well: What has improved since the last inspection? What they could do better: Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 7 Improve and ensure consistent record keeping practises, including in respect of people’s individual needs assessment, care planning and medicines records in order to effectively provide accountability for practise. Consider the implications of the Mental Capacity Act 2005 in respect of maximising people’s capacity to exercise personal autonomy and choice in their lives by accounting for this within their individual needs assessment and care planning documentation. Ensure food menus are provided for people and are accessible to them in advance of meals being served. Use a recognised staffing tool to determine staffing levels in accordance with people’s actual needs and not purely the number of people accommodated. Ensure that two references are always obtained as requested before a person commences work at the home. Ensure that the acting manager promptly submits an application for registration with the Commission. Ensure that information requested in our annual quality assurance questionnaire is fully provided. And in this instance that evidence is also provided and available for inspection in the home detailing all required service and maintenance information. 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.V370167.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.V370167.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. (NMS 6 was not assessed, as this standard is not applicable 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 suitably informed to assist them in choosing to live at the home and for the most part their needs are being met, although people’s needs assessment records do not effectively account for practise. EVIDENCE: At our last key inspection of this service we judged that people are provided with a range of information about the home and its services, although the service guide did not clearly inform people 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. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 10 We also considered that 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. We made a requirement for the home to ensure they provide clear information about fees charged and what they cover within their service guide. This is achieved at this inspection and this information is provided within the home’s service guide, which is also available in large print format. In our annual quality assurance questionnaire completed by the home, they say that people are provided with the information they need about the home, that their needs are assessed and that they are invited to visit the home before moving there. They did not identify any improvements that they have made or aim to achieve within the next twelve months in relation to this outcome section. At this inspection people told us that they were not able to recall receiving a written contract, although their families assisted them in this respect. All said they received sufficient information about the home to help them to make a decision to live there. Comments received from people included: I was determined to come to the Manor because I used to come for day care and decided I would come here full time.’ ‘Before I lived here, my husband already lived here for approximately 1 year. Very pleased with home.’ ‘I had a choice of three and this was the best. Standardised documentation is in place for staff to record people’s needs assessment information, the format of which accords with a recognised practise. These were only fully completed in respect of one of the three people we case tracked. For two, although there was some initial assessment information recorded, information about people’s needs was not fully recorded, although for most, copies of the needs assessment summaries and care plans were provided as carried out by local authority care management arrangements, although one related to their care received in the community and was not directly relevant to their placement at the home. In addition, the home’ internal monthly home audit undertaken by management on 23 July 2008 identifies action required in respect of record keeping practises in relation to peoples’ individual needs assessment and care planning records. (See also the Management section of this report). Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 11 Discussions with staff and those people indicate that staff, is mostly conversant with their needs and all people told us that they always receive the care and support they need. Although for the person referred to above, staff felt they did not have the information they needed to be able to fully provide the care that person may need. We discussed this with management who agreed to review this. Holmewood Manor Care Home DS0000064198.V370167.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 needs are reasonably well met, although recent omissions in medicines record keeping undermine accountability for practise. EVIDENCE: At our last key inspection we judged, that people’s health care and personal support needs are reasonably well met and in a more sensitive manner. We also judged that the home’s drive to improve its systems and approaches to individuals’ care had effected notable key areas of improvement, which, if fully implemented and sustained should consistently ensure that people’s needs are met in a manner of sensitivity and respect. We made one requirement (extended timescale from previous inspection) – to ensure that the introduction of the revised care-planning format be fully completed. This is achieved at this inspection. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 13 In our annual quality assurance questionnaire completed by the home, they say that people’s care plans are up to date and detail the actual care people need and, that these are regularly reviewed in accordance with people’s risk assessed needs. And, they identify these as key improvements that they have made over the last twelve months. They also say they have improved their record keeping in respect of their daily evaluation of people’s care. Have introduced a communication book for staff and monitor people’s health, ensuring liaison with outside health care professionals as necessary. They feel they could improve further by ensuring better guidance/clearer instructions for staff as to medicines to be given as required and that they aim to improve over the coming months by ensuring all staff receive care planning training. At this inspection nine out of ten people surveyed tell us they always receive the care and support they need and one said they usually do. One of the people we case tracked said they usually do and two were unable to provide clear information about this due to their confusion. All ten people surveyed tell us staff always listen and act on what they say and also the person case tracked referred to above. Six tell us that they always receive the medical support they need and four say they usually do. The person we case tracked who we were able to converse effectively with said they usually do, although was unsure about some recent changes to their prescribed medicines. Our Expert by Experience told us that staff observed demonstrated a good caring approach towards people. People’s written care planning documentation and medicines administration records was variable in the standard of record keeping and completion, with significant omissions in the recording of the latter from 25 July to the date of our inspection visit and also for one of the people we case tracked. And as we have stated previously, for one person case tracked (referred to above), their needs assessment and care plan provided via local authority care management arrangements related to previous care they received in the community and was not specific to their placement at the home. Staff expressed some difficulties in providing care and support for that person. We discussed these with management who agreed to review this as a priority. They also provided us with a copy of their last monthly internal medicines audit dated 23 July 2008, which indicated overall satisfactory outcomes in relation to medicines practises, including record keeping for the four service users whose records they sampled on that date for the purpose of their audit. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 14 Staff responsible for the administration of medicines told us they have received training for these and their individual training records confirm this. Further refresh training is also planned for September 2008. Immediately following our inspection visit the regional manager for the service has provided us with a written action plan in respect of the issues we have raised with them about their medicines administration record keeping. We will monitor their compliance with these via our inspection process. The home’s internal monthly home audit, last undertaken on 23 July 2008 includes an audit of care planning documentation, for four identified people whose care records they sampled. These indicate that written care plans sampled correspond to people’s assessed risks and identified needs as documented, although audit results for one person showed areas of omission in respect of the recording of their needs assessment information (see Choice of Home section of this report). An action plan was in place in respect of these, which details who will be responsible for the action. (See also the Management section of this report). Holmewood Manor Care Home DS0000064198.V370167.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): 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’s lifestyles at the home usually accord with their expectations and preferences and they are provided with nutritious food. Although their individual capacities to exercise choice and control over their lives could be better accounted for within their care planning documentation. EVIDENCE: At our last key inspection of this service we judged that people were well informed and provided with a range of activities, which usually accord their people’s choices and preferences We also judged that people were provided with a good standard of food, which accounts for their individual preferences and risk assessed needs. In our annual quality assurance questionnaire completed by the home, they say that they employ a full time activities co-ordinator to promote people’s Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 16 occupation, leisure and spiritual preferences. They also tell us that people are provided with balanced and nutritious meals, in a choice of surroundings. They tell us they have improved their meals provision for people by way of employing a second chef. And that they could do better by improving access for people to the local community and also in their record keeping in respect of activities. Although, they do not indicate any actual improvements they intend to make over the coming twelve months. At this inspection people told us that majority of people told us that activities are always arranged by the home that they can take part in, with four saying that they usually are. Comments received from the latter include: ‘I like to do my own thing.’ ‘I take part if I want to.’ The majority of people say they always like the meals provided and four said they usually do. A number of comments were made via survey returns and directly to our Expert by Experience. These included: ‘Excellent food.’ ‘The food is always lovely – sometimes we have a choice, sometimes we don’t.’ ‘The quality of food is good.’ ‘The chef is off at the moment, we have had arctic roll three days running, but he food is usually very good.’ Our Expert by Experience observed that the activities arranged for the residents varied and that on the morning of the inspection Bingo was played, and the caller was one of the residents. She observed the notice board, where a list of various activities was printed, which included arts and crafts, pampering, different food tasting, music, videos and a cinema day. Several residents told her they were happy to take part in the activities, but others said they were not interested. We spoke with the activities-co-ordinator during our inspection visit and she advised that she was seeking to develop opportunities for people to access the local community and was already supporting a group of people to access a weekly coffee morning held in the village. An external group called Progressive Mobility provide gently exercise group activity for people on a fortnightly basis and the home has become a member of NAPA (National Association for Providers of Activities for Older People). An Autumn Fayre was also planned. Our Expert also observed that many residents sat in the dining room downstairs for their lunch, although there is an additional dining room upstairs. One person, case tracked told us that he liked to stay in his own room for meals, which staff accommodated. Our Expert observed that lunch on the day of the inspection was Shepherds pie, cabbage, cauliflower, Yorkshire pudding Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 17 and gravy, followed by Arctic Roll and fruit. The meal was accompanied with either blackcurrant, orange or water served in glasses. Our Expert asked to see the menu, although, staff was unable to find one. She observed that the board hanging up in the dining room by the serving hatch did not have the lunch menu written on it, until after the residents had all sat down. But, that the residents appeared to enjoy their food, which looked appetising. She observed that the tables in the dining room had table linen and glasses and when the tables were not set for lunch there was posies of flowers on them. She also reported that residents, who needed help to get to the dining room, were assisted in a dignified manner and at no time were they rushed or impatiently dealt with. Peoples’ rooms that we looked at via case tracking were personalised and they told us that they were encouraged to bring their personal possessions with them. However, people said they did not access their own care plans and their care records did not provide clear information as to their individual capacities to exercise choice and control over their lives, such as accessing and determining their written care plans, handling their own financial affairs and managing their own medicines. All people accommodated are British white of Christian based religion, either practising or non-practising, which is usually individually recorded within their care records. People also have lifestyle profiles, which are usually recorded within their individual care records. Holmewood Manor Care Home DS0000064198.V370167.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. People’s rights to complain and to be protected from abuse are taken seriously and acted upon. EVIDENCE: At our last key inspection of this service we judged that the management and handling of complaints by the home and its systems and arrangements for the safeguarding of people from abuse and harm provided good assurance that their best interests and safety is being effectively promoted and protected. In our annual quality assurance questionnaire completed by the home they say that they always provide people with information about how to complain, keep full records as to complaints received, liaise with outside agencies as appropriate and ensure that staff are trained in respect of recognising and dealing with abuse. They say they have improved over the last twelve months in terms of a reduction in the number of complaints they have received. They also tell us they could improve by ensuring more timely investigation of complaints and they say they intend to improve their approach to complaints Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 19 over the coming twelve months by maintaining staff training and in employing the company’s policies and procedures in relation to these. Since our last key inspection of this service we have received three anonymous complaints alleging inadequate staffing levels at the home. We carried out an unannounced random inspection visit to the home on 28 January 2008 and following our visit we wrote to the provider raising serious concerns about staffing arrangements at the home and told them what action we expected them to take, which they complied with. At this inspection people surveyed and spoken with tell us they always know who to speak to if they are not happy and one person told us they usually do. All of the above told us they know how to make a complaint The home has received three complaints since our last key inspection, all of these relate to staff conduct issues. One was substantiated and reported to the agency supplying a named carer, one was investigated via joint agency safeguarding procedures, although was not substantiated and one was investigated by the home, which was also not substantiated. Records are in place at the home in respect of all complaints received, their investigation, outcomes and action taken where appropriate. The home also provided us with written notification about each of the complaints they received. Staff spoken with is conversant with their roles and responsibilities for handling complaints, recognising abuse and reporting procedures in respect of the latter. The home provides staff with training in recognising abuse and safeguarding people as part of a rolling programme and staff is provided with key policy and procedural guidance for these during their induction. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 20 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): NMS 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People continue to benefit from an overall well maintained, safe and homely environment, which suits their needs. EVIDENCE: At our last key inspection of this service we judged that The environment well promotes people’s comfort, safety and wellbeing, including opportunities for their stimulation and relaxation and suits their needs. In our annual quality assurance questionnaire completed by the home they say that they provide people with a safe and homely environment, which is equipped and personalised to meet with individual’s needs and choices. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 21 They tell us they could do better by ensuring a daily walk about of the environment with attention to providing an action plan to meet any environmental targets. However, they do not identify any key improvements made over the last twelve months, or any for the coming months. At this inspection three people surveyed told us that the home is usually fresh and clean and all others told us it always is. Our Expert by Experience commented that lounge and dining areas she accessed were fresh and clean and welcoming. Then communal and private accommodation that we looked at for those people case tracked was safe, clean, odour free and decorated and furnished to a good standard and suitably equipped. The external grounds were redeveloped around a year ago and people told us that they enjoy the various areas of the garden, which provide relaxation and stimulation and also a raised vegetable garden. The manager provided us with details of the home’s most recent monthly environmental audit, undertaken by external management and with an outcome score of 93 against a possible 100 . An action plan was in place in respect of minor areas of repair and replacement resulting from this audit. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 22 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): NMS 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’s needs are usually met and they are supported by staff, that is mostly trained and competent to do their jobs. However, the methodology used to determine staffing levels does not accord with best/recognised practise, which may not always be in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that people are protected by the homes’ recruitment practises and the improvements in staff induction and training arrangements to be clearly in people’s best interests. However, staff deployment arrangements might not always be consistently so. We made a requirement, that at all times there must be sufficient numbers of care staff working at the home as appropriate for the health and welfare of the people who live there. The provider sent us an action plan telling us what they were going to do to ensure this, which was satisfactory in principle. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 23 We also recommended that 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. Since that inspection we received three anonymous complaints alleging inadequate staffing arrangements at the home, including the number of staff provided and also relating to some aspects of training. We carried out an unannounced random inspection visit to the home on 28 January 2008 and as a result of that inspection we made two further requirements, that: Sufficient and suitable kitchen staff cover must be provided. In the absence of kitchen staff, where any care staff is involved in the preparation of food in the kitchen these hours must be additional to care staff hours required for personal care. And, that staff working in the kitchen responsible for food handling and preparation must be suitably trained to do so. We wrote to the provider about our concerns regarding the above and told them what action they must take, which they complied with. In our annual quality assurance questionnaire completed by the home, they say that staff is suitably recruited, inducted, trained and deployed and that they have sought to ensure the improvement of staff morale over the last twelve months. They say they could improve further by ensuring sufficient staff is employed as they use agency staff on a regular basis, and aim to improve further over the coming months by increase the number of staff having NVQ levels 2 and 3. They also advise us that four out of thirteen care staff employed hold an NVQ level 2 in care or above, with eight care staff working towards an NVQ level 2. At this inspection eight people out of eleven told us that staff is always available when they need them and three said they usually are. Comments received included: ‘If staff are busy helping someone else, they usually let me know when they will be available.’ ‘Staff are brilliant and look after me well.’ Staff told us about the arrangements for their recruitment, induction and training, which overall are satisfactory and records examined supported were Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 24 reflective of this, including for catering staff. Although for one care staff more recently employed, only one reference was obtained to date from two referees details they had supplied in their application. Staff training needs are analysed on a monthly basis via the home’s management auditing systems and there is a training plan in place, which is regularly reviewed in consideration to identified areas of deficit. Some staff told us that they felt more prompt management action is required to ensure sufficient care staffing levels in response to increases in resident numbers and/or dependencies. We were however advised that care-staffing levels had very recently been increased, to provide an additional carer throughout the day, which was felt by staff to now be satisfactory, although not timely in its application. Staff rotas examined reflected this. We discussed the arrangements for staff deployment with the acting manager, who confirmed that a recognised dependency assessment or staffing tool is not used to inform staff deployment planning. She advised that the company determine the home’s staffing ratio, but was unable to provide any evidence base to their determination of this. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 25 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, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is reasonably well managed and for the most part, in peoples’ best interests. EVIDENCE: At our last key inspection of this service we judged that the deployment of good interim management arrangements had resulted in key improvements in the service, which if permanently and suitably secured should ensure that the home continues to run in people’s best interests. We made a requirement that a suitable manager be appointed for the home. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 26 In our annual quality assurance questionnaire completed by the home they say that the home is now well managed in people’s best interests. They also say that over the last twelve months they have improved in their staff training achievement statistics in relation to core health and safety training areas. They feel they could further improve staff team working and aim to do so over the coming months by way of individual supervision, mentoring and monitoring. They also tell us that they aim to establish relatives meetings. They do not give us maintenance details as requested within part of our questionnaire re electrical hard wiring and portable appliances. At this inspection we spoke with the acting manager for the service, appointed on 05 November 2007. To date we have received no registration application from her. She advised that this was complete and would be submitted imminently. The acting manager is currently responsible for the management of two care homes located on the same site, with support from named deputies for each and from external management arrangements. Monthly home audits are introduced covering all aspects of the service and we are provided with a copy of that undertaken on 23 July 2008. This clearly identifies findings by way of a scoring system for each area and with an action plan with dates set for achievement. Areas where action is identified are referred to under relevant sections of this report and also include matters relating to this outcome section including, identified strategies for formal consultation with people who use the service (including implementing a formal newsletter, meetings and surgeries), storage of waste, recording of accidents, record keeping (in respect of people’s written care plans and needs assessments), staff supervision, residents monies, control of substances hazardous to health, achievement of 90 target for core health and safety training for staff, staff supervision and Environmental Health Officer recommendations from their recent visit. We will monitor progress with these at our next inspection of this service. However, there was no up to date information in place in respect of the servicing and maintenance of portable appliances and electrical hard wiring at the home. Copies of the reports of the monthly visits from a representative of the registered provider, is also kept in the home and are suitably recorded. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 27 Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 28 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 2 2 2 Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement A person must not be accommodated at the home unless their needs have been fully assessed by a suitable person and the home has obtained a copy of their care management assessment relevant to their intended placement there (and care plan). This is to ensure that their needs can be met by the home. Care plans must always be drawn up for each person immediately following their admission, within a reasonable timescale (detailing the action, which needs to be taken by care staff to ensure that all aspects of their health, personal and social care needs are met). Medicines administration records must be properly maintained in accordance with recognised standards of practises for medicines record keeping: Medicines must be administered as prescribed and staff responsible for these must sign to indicate when a medicine is administered. If a medicine is DS0000064198.V370167.R01.S.doc Timescale for action 05/10/08 2. OP7 15 05/10/08 3. OP9 13(2) 05/10/08 Holmewood Manor Care Home Version 5.2 Page 30 4. 5. OP31 OP38 8, CSA Sec 11 13(4) & 23(2) not administered for any reason, the coded reason for its nonadministration must be recorded and where necessary a hand written record as to the reason for this must be entered into that persons daily care record or medicines care plan evaluation. Hand written medicines instructions must be clearly written and always detail the type of medicine to be administered, the dose, the route of administration and the times it is to be given along with the start date and where necessary the stop date (if prescribed a short course). This is to ensure that people receive the medicines they are prescribed and to reduce the risk of error. The acting manager must submit 05/10/08 an application for registration with the Commission. All part of the home to which 05/10/08 service users have access must be free from hazards to their safety and the home kept in a state of good repair. A copy of the electrical hardwiring certificate must be provided, which must be up to date. Records of portable appliance testing must be kept at the home maintained up to date. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 31 No. 1. Refer to Standard OP3 Good Practice Recommendations Each service user should have a plan of care for daily living and longer-term outcomes based on their Care Management assessment and Care Plan (or for privately funded residents, the home’s own needs assessment). The home’s admission policy and procedures should determine an agreed standard timescale for ensuring the provision of initial key care plans for people. Where a medicines instruction is hand written onto the medicines administration record sheet, it should be signed and dated by the person writing it and countersigned and dated by a witnessing staff member. Consideration should be given to the implications of the Mental Capacity Act 2005 in respect maximising people’s capacity to exercise personal autonomy and choice in their lives and by clearly accounting for this within individuals’ needs assessment and care planning documentation. Menus should be provided for people and should be readily accessible to them in advance of meals being served. A recognised staffing tool should be used to determine staffing levels, which should be effectively applied to ensure that staffing levels accord with people’s needs and not purely the number of people accommodated. Where a request for a reference for any staff member is not supplied for any reason, that staff member should be asked to provide an alternative referee to ensure that two references are always obtained in respect of each person to be employed at the home (and before a person commences working at the home). 2. 3. OP7 OP9 5 OP14 6. 7. OP15 OP27 8. OP29 Holmewood Manor Care Home DS0000064198.V370167.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V370167.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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