Inspection on 14/12/06 for Holmewood Residential Care Home

This inspection was carried out on 14th December 2006.

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

The inspector 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 Residential Care Home 30/10/08

Holmewood Residential Care Home 11/10/07

Holmewood Residential Care Home 26/01/06

Holmewood Residential Care Home 13/05/05

Holmewood Residential Care Home 10/01/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Holmewood Residential Care Home Holmewood Lamplugh Road Cockermouth Cumbria CA13 0DP Lead Inspector D Jinks Unannounced Inspection 10:00 14 December 2006 th 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 Residential Care Home DS0000061658.V314746.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 Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmewood Residential Care Home Address Holmewood Lamplugh Road Cockermouth Cumbria CA13 0DP 01900 828664 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) Lakeland Care Services Ltd Melanie Gilmore Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 26 service users in the category of OP (old age, not falling within any other category). 26th January 2006 Date of last inspection Brief Description of the Service: Holmewood offers accommodation and care for up to 26 older adults. The home is decorated and furnished to a good standard, is pleasant and comfortable. All of the bedrooms are for single occupancy, but one can be used for two people sharing if requested, they are spacious and individually decorated and furnished. All of the bedrooms have an en-suite toilet and bath or shower. The home has several communal lounges and a dining room. There is a passenger lift, a platform lift to assist with three stairs, handrails, grab rails and a range of equipment to assist people in their day-to-day lives. The home is set in large well-maintained gardens, including a vegetable garden seating areas and a large car park. The weekly fees for this home are from £475.00 per week. There are extra charges for hairdressing, magazines, chiropodists and other personal items that service users may wish to have. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The assessment of this service included an unannounced visit to the home, discussions with the manager and staff at the home as well as meeting and talking to some of the people living there. During this visit all the key standards of the National Minimum Standards were assessed. Questionnaires were sent out to people living at the home, their relatives/representatives and health and social care professionals. These helped to obtain personal views of the services provided by the home from people with varied backgrounds and experiences. The registered manager had completed a pre-inspection questionnaire prior to this visit. This assisted in verifying information throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Improvements need to be made to the way in which new staff are recruited. The manager must ensure that staff are properly vetted before they commence work at the home and properly supervised once they are employed. Improvements also need to be made to make sure that records are kept up to date and are accurate. Particular attention should be given to service user’s care plans and risk assessments. Staff training records must also be completed to reflect the training that they have undertaken and help identify the training that still needs to be carried out. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of need are obtained prior to service users moving into the home. Prospective service users and their family/relatives are provided with sufficient information about the home to help them make an informed choice. EVIDENCE: Full and detailed needs assessments are carried out by social services or the primary care trust as applicable. The manager obtains copies of the assessments and care plans of prospective service users prior to their admission to the home. This helps to ensure that the home will be a suitable place for the person to live and that all their needs will be met appropriately. On admission to the home, the manager carries out an initial assessment of the service user to help verify their needs and expectations. Service users/relatives completing questionnaires or spoken to indicate that they were able to look around the home prior to moving in and were fully informed about the services the home could provide. They indicated that they were given all the information necessary before making a decision. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are generally treated with respect, dignity and their right to privacy is upheld. However, the lack of information in care plans may compromise this at times. EVIDENCE: Service user records contain care plans, which are kept under regular review. Daily notes are kept recording details of significant events in the daily lives of people living at the home. These notes indicate that residents have access to health care professionals such as district nurses, doctors, opticians and chiropodists. Nutritional assessments are not undertaken when service users are admitted to the home. Where possible weights are recorded and monitored at frequent intervals. Monthly notes, summarising the events affecting service users are written and placed on their personal file. These are currently used as the review of their care needs. Care plans are not amended to reflect any changes in service user’s care needs. Care plans include some detail of the daily needs of residents and how these should be met. They recognise and respect the level of support required by each service user in order to help maintain their independence. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 10 The manager indicated that new care plans and recording methods are to be introduced to help ensure that identified changes in needs are acknowledged and transferred to the care plan. A sample of the new system was seen during this visit. The risk assessment elements of care plans are poorly completed and lack sufficient details and strategies for staff to follow. Some service users had been identified as being at risk of falling and bed rails had been in place in the case of one service user. These matters had not been included in the care plan or risk assessment. One service user was recorded as having some ‘short term memory loss’ and of leaving the home without letting someone know when they go out – these arrangements have not been properly assessed and again there are no recorded strategies in place to help ensure the safety of the service user whilst remaining mindful of respecting choice and independence. There is a medication policy and procedure at the home. This is generally followed by the staff responsible for the administration of medication. There are a number of staff with responsibility for medication administration. Training has been provided to help minimise any risks to service users. Photographs of service users are kept with the medication records to further assist with identification and help minimise the risk of errors. Medication records are accurately maintained and the home has a good relationship with the local pharmacist, who checks the medication arrangements at the home monthly. Medication is stored securely. The temperature of the medication storage cupboard/room is rather warm and needs some attention to ensure that medication is stored within the correct temperature limits. The manager obtains up to date patient information leaflets from the pharmacy, this helps to ensure that medication is given correctly and as prescribed. Verbal instructions regarding medication are sometimes given to the manager by doctors. Sometimes this is followed up immediately by written instructions but this is not consistently carried out. It would be good practice for the home to develop a process for dealing with such changes, including a recording process and staff double-checking instructions from the prescribing doctor. Service users are treated with respect and dignity. Health care professionals confirm that they are able to see their patients in the privacy of their own rooms. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are given opportunities to participate in leisure, social and cultural activities. EVIDENCE: There are various activities and social events available to people living at the home. Residents may choose whether to take part or not. Examples include: trips out, communion services at the home, musical entertainment, bingo, dominoes and other games. At the time of this visit the home was tastefully decorated ready for Christmas and the residents were looking forward to the Christmas party and other celebrations. Relatives and visitors are made welcome at the home and residents are able to see their visitors in one of the communal areas or in the privacy of their own rooms. Daily records show that service users participate in activities that interest them and also go out with their relatives and friends frequently. Staff were observed working with residents. There is a happy and positive rapport between them. Service users are treated with respect and dignity. Staff are mindful of the need for privacy and knocked on doors before entering, ensure that doors are closed when necessary and residents are called by their preferred name. Staff are described by visitors and residents as ‘very caring and non-patronising’. Residents and visitors feel comfortable and satisfied with the care they receive – ‘staff are Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 12 very approachable and caring’, ‘taking time to remember my likes and dislikes’. Residents indicate that the food is very good at the home, with plenty of variety and choice. The standard of food is described as being ‘very high’. Comments received suggest that perhaps there could be more hot choices available at the evening meal. Discussion with residents, the manager and cook indicate that there are choices at the evening meal, including a hot option. The menus confirm that there is a choice but the evening menu is basic with very little information recorded. In comparison the lunchtime options are very detailed and include information about the type of vegetables that will be served. The menus would benefit from a review of the information contained in them so that service users are fully informed of the options available to them. It would be good practice as part of the review to consult with service users and obtain their views regarding food, choices and menus. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are confident that their comments and concerns will be listened to, taken seriously and acted upon. EVIDENCE: There are policies and procedures in relation to adult protection in place at the home. These documents are in need of review to ensure that current good practice and legislation is reflected throughout. There is a complaint process available and residents and their relatives are aware of whom to speak to if they have concerns or problems. The home has not received any complaints recently. The manager keeps a record of any comments and complaints, which helps to identify any areas of the home and home life that might need improvement. People taking part in the inspection indicate that they are generally very satisfied with the service they receive and ‘couldn’t fault it’. They also indicate that staff listen to them and act on any issues that they might have. Staff at the home have generally not received training regarding the mistreatment of adults. The manager is hoping to arrange this training in the near future. Some staff have a basic awareness of this subject, which is included in their induction training. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, clean and well-maintained environment. EVIDENCE: People living at the home commented on the cleanliness of the environment. The home is clean, tidy, warm and homely. Housekeepers are employed at the home and are responsible for the cleanliness. On the day of the visit the home was tastefully and brightly decorated ready for Christmas. Resident’s rooms are bright and cheerful and are en-suite with either a private bath or shower. People living at the home are able to personalise their own rooms with ornaments, pictures and furniture. One person participating in the inspection commented that they are ‘allowed to have my own bits and pieces in my room which helps me to feel at home’. In addition to the en-suite bathrooms there is a communal bathroom, which is equipped with a specially adapted bath for less mobile residents. This room is decorated to a high standard and is warm and clean. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 15 There is a laundry in the basement of the home. This is kept clean and tidy. There are special laundry bags available for heavily soiled laundry and staff are provided with protective gloves and aprons to help prevent the spread of any infection. The fire safety officer has recently visited the home. Fire records, equipment and the home’s fire risk assessment were checked and no issues or concerns were identified. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 16 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are generally satisfied with the standard of care and support that they receive. They may not always be protected by the recruitment practices in place at the home. EVIDENCE: Service users and visitors to the home indicate that the staff are very good, caring, kind and friendly. They also feel that there are sufficient staff on duty to attend to their needs. Recruitment practices at the home are unsafe and need to be reviewed. Staff are sometimes employed before the manager has obtained all the necessary information including; criminal record bureau checks (CRB), references from previous employers and checking the protection of vulnerable adults list (POVA). In addition to these shortfalls, staff are not monitored and supervised as required. These gaps potentially place service users at risk from harm or abuse. There is some evidence of staff training taking place but training records are not fully completed and up to date. The manager is in the early stages of devising a staff training and development plan to help improve this. Some staff supervision takes place and this has helped to identify some of the areas that staff need or would like training in. Training that has taken place includes manual handling, dementia awareness, medication administration, first aid and induction training. Several members of staff have completed are undertaking National Vocational Qualifications (NVQ) in Care. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 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 generally run in the best interests of service users. EVIDENCE: The home is run by a qualified and registered manager. She has extensive experience of working with older adults in a residential care setting. The service is planned to be user focused, and generally works in partnership with the families of residents and health and social care professionals. There are policies and procedures at the home to help ensure that residents and staff are safe and protected. Some of these policies need to be reviewed to reflect good practices and changes to legislation. Records are generally kept in good order and up to date. There are some gaps in the recording system that need attention, particularly health and safety, risk assessments and care planning. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 18 The home does not have any facilities to store resident’s valuables and service users are encouraged to ask families, solicitors or banks to provide this service. The home is not responsible for managing the finances of any service users. They are encouraged to manage their own affairs. Residents may ask the home to keep very small amounts of money (used for day to day items such as hairdressing/shopping). The home has a safe storage place for this and adequate records and receipts are kept. The home is maintained to a high standard. General safety checks are made frequently and records are kept. The kitchen areas are clean and hygienic, with food stored appropriately, covered and dated. Kitchen staff participate in food hygiene training and their induction training includes the use of the kitchen equipment. Staff supervision is carried out but is not carried out as frequently as it should be and the manager does not follow the special arrangements for staff awaiting the results of criminal record bureau checks. Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X 4 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 2 Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 20 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 OP30 Regulation 18 Requirement The registered manager must ensure that there is a training and development plan at the home to ensure that all staff have the necessary training to meet the aims of the home and the changing care needs of service users. This includes, but is not limited to adult protection, manual handling and health and safety. (Previous timescale of 30/04/06 not met). The registered manager must ensure that all staff receive formal supervision at least 6 times per year. Supervision should cover all aspects of practice, philosophy of care in the home and career development needs of the staff. (Previous timescale of 31/03/06 not met). The registered person must ensure that each service user has a comprehensive plan of care. The plan must set out in detail the action that needs to be taken by staff to ensure that all DS0000061658.V314746.R01.S.doc Timescale for action 31/03/07 2. OP36 18(2) 28/02/07 3. OP7 15 31/01/07 Holmewood Residential Care Home Version 5.2 Page 21 4. OP8 12, 13, 14, 15 and 17 5. OP18 13(6) 6. OP29 18(2) 19(1–11) 7. OP37 17 13(4) aspects of the service users needs are met and the outcomes achieved. Care plans must be reviewed at least monthly and any changes to the service users needs must be clearly recorded in the plan. The registered person must ensure that nutritional screening is undertaken on admission of a service user and subsequently on a periodic basis, with a record maintained. The registered person must ensure that the policies and procedures in relation to the protection of vulnerable adults are reviewed and up dated in line with local multi-disciplinary guidance and current legislation. The registered person must review the staff recruitment practices and procedures at the home. Amendments must be made in line with current legislation and good practice to ensure that inappropriate staff are not selected to work with vulnerable adults. This must include obtaining two written references and at least a POVA First check prior to staff working at the home. The registered person must ensure that records are accurately maintained and up to date. This includes staff recruitment records, training records, service user care plans and health and safety risk assessments. 31/01/07 28/02/07 31/01/07 31/01/07 Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 22 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 OP9 Good Practice Recommendations It is recommended that the temperature of the medication storeroom is monitored daily to help ensure that medication is stored at the correct temperatures. Where it is found that correct temperatures cannot be consistently maintained, arrangements should be made to address this. It is recommended that the menus, particularly the evening meals, be reviewed, in consultation with service users. Particular attention should be given to the amount of information regarding the choices available so that service users are fully informed. 2. OP15 Holmewood Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Residential Care Home DS0000061658.V314746.R01.S.doc Version 5.2 Page 24 - 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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