CARE HOMES FOR OLDER PEOPLE
Holmfield 4 Darley Avenue West Didsbury Manchester M20 2XF Lead Inspector
Helen Dempster Unannounced Inspection 14th November 2006 12:00 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 Holmfield DS0000067934.V319303.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. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Holmfield Address 4 Darley Avenue West Didsbury Manchester M20 2XF 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) 0161 434 1480 0161 434 1480 Age Concern Manchester Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of 32 older people (OP) requiring personal care only may be accommodated. Date of last inspection Brief Description of the Service: Holmfield Care Home is registered to provide personal care for up to 32 older people. The service is owned and managed by Age Concern Manchester, who purchased the service from the former owners in July 2006. The home is a large detached building in West Didsbury, south of Manchester City Centre. and is situated in a residential area close to local shops and community facilities. Public transport links into Manchester and Stockport City Centres are within easy walking distance. The home is set in extensive and well-maintained grounds and the home employed a gardener to ensure that residents are able to enjoy the garden and sit outside when the weather is good. Safe wheelchair access is provided at the back of the building. The home has 6 double bedrooms and 20 single bedrooms. It has 3 lounge areas. Visitors can see residents in privacy in their bedrooms or in the lounge areas. All bedrooms at the home are fitted with emergency call systems and hand washbasins. Residents are encouraged to bring their own furniture, photographs and personal things to make their bedrooms homely. Bathroom and toilet facilities are sufficient to meet residents’ needs and are located close to bedrooms and communal areas. The fees charged by the home are £370:00 per week for a shared room and £380:00 per week for a single room. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home had been purchased by Age Concern in July 2006, so this inspection was the first inspection of the new service. The inspection was conducted by gathering lots of information about how well the home was meeting the National Minimum Standards. This included the manager filling in a questionnaire about the home, which gave information about the residents, the staff and the building. Questionnaires about the service were sent to the home prior to the inspection and six residents’ relatives posted completed questionnaires to the inspector. The inspection also included carrying out an unannounced site visit to the home on 14 November 2006 from 12pm to 7pm. During this visit, lots of information about the way that the home was run was gathered and time was taken in talking with the residents, the manager, a senior manager from Age Concern and the staff team about the day-to-day care and what living at the home was like for the residents. Other information was also used to produce this report. This included reports about events affecting residents that the home had informed the Commission about. The main focus of the inspection was to understand how the home was meeting the needs of the residents and how well the staff were themselves supported by the home to make sure that they had the skills, training and support to meet the needs of the residents. The inspection also focused on how the owners of the service had addressed some of the issues, which they were committed to improving when they purchased the service. What the service does well:
Since Age Concern had purchased the service, they were doing many things very well. These included the following: The service made sure that residents’ wants, needs and requirements were looked at before they moved into the home. The manager, or a senior member of staff, visiting the person before they were admitted, did this. In this visit, cultural needs, food, social needs and mobility (including wheelchair access) were looked at and recorded. This is good for the residents and residents’ relatives were pleased about this. The service made sure that residents’ choices and rights were respected and that care could be given to each individual resident in the way they preferred and that this was written down on their care plan. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 6 Residents said that they were treated with respect and that their rights were respected. Residents’ relatives were also happy about the way the staff treated the residents. One relative said that all residents were “treated with dignity and respect and everything possible is done to make their lives as pleasurable as possible”. Residents’ medication was well managed, records were accurate and staff training had been arranged. Residents and their relatives were pleased with activities at the home and the home uses a newsletter so that residents and their relatives know what entertainment is planned and what improvements and changes are planned. This is good for the residents and their relatives. One relative said that the home “lists the activities in the home each week and visitors are welcome to attend any they wish”. Another relative said that activities are “very good and stimulating”. Residents and their relatives said food was good, including one relative who said in a questionnaire that the meals were “first class- a varied menu and a good choice….My mother enjoys every meal and looks forward to them”. Residents and their relatives were pleased with the staff. Three of the residents’ relatives who filled in questionnaires said that staff were always available when you needed them and the other 3 said that they usually were. Residents’ relatives talked about staff being “fantastic”, “wonderful” and “always help when I ask”. One relative said that staff “go out of their way to help me”. Another relative said that staff could be asked for help “at any time, night or day”. This relative added, “ If I ring up during the evening, someone is always there to answer my questions”. Residents also said that the staff were good and that they received the help they needed. This is good for residents and their relatives. Residents and their relatives spoke well of the manager. One resident’s relative said that she was “lovely” and that she always went round all the residents to chat with them every morning and took part in activities and trips out. Another relative, who filled in a questionnaire, said that she can “speak to the manager and assistant manager, who always have time to listen”. This is good for the residents and their relatives. What has improved since the last inspection?
As stated earlier, this was the first inspection of the home since Age Concern had purchased it in July 2006. During the inspection, staff, residents and their relatives talked about improvements made in the home since this time. These improvements include the following: The cook talked about menus being much better to provide daily alternative choices of meals and a bigger range of food. He said that as he now served meals, he saw residents every day and was able to discuss and notice likes and dislikes so he could give residents the food they liked.
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 7 Age concern had made improvements to the building. This included putting in a new fire alarm system and emergency call system in residents’ rooms for safety reasons. Age Concern also planned to redecorate and replace furniture and fittings to improve the building for residents. Age Concern had improved the way they recruited staff at the home, which was good for residents’ health and wellbeing. All the staff spoken to were pleased that they now had regular appraisals and good access to training. They talked about having a good relationship with the manager. Staff were also pleased that Age Concern had made many improvements, including improved activities for residents. Staff were pleased that they were able to take individual residents out shopping. Staff stated that they had “more respect”, “better working conditions” and “more involvement”. Two newly recruited staff said that the management and staff team had welcomed them. They said that equal opportunities in the organisation was good and that they had not experienced any discrimination. Staff said that the manager “listens to you” and “trusts you”. This is good for the staff and the residents. What they could do better:
There were some things that the manager was aware that she needed to improve and these things included the following: Residents would benefit from having a clear contract about their stay at the home. The service needed to make written information about the home more easily available to new residents and their families to help them to make a choice. The service needed to improve day to day communication about residents and staff handovers between shifts. Examples included the need to be more careful to act on any changes in a resident’s needs, which staff had noticed and written down in day-to-day records. The service also needed to review the care plans regularly and to write down changes on the care plan. The service needed to improve risk assessments about residents’ day-to-day risks and to review these regularly. Residents would benefit from having easy access to a clear complaints procedure. The service needed to use questionnaires and to write down what residents and their relatives say about how the home is run, what is good and what could be improved. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 8 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. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 9 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 Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and staff were giving existing residents and their relatives some information about the service. However, they needed to make written information about the home more readily available to prospective residents and their families to help them to make a choice. EVIDENCE: At the time of the purchase of the service, Age concern wrote to all the residents and their relatives to inform them of the change of ownership. Age Concern had completed a first draft of a Statement of Purpose and Service Users Guide, but, at the time of inspection, this was not ready to be given to new and existing residents. The need for the final version of these documents to be made readily available to prospective residents was discussed. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 11 There had been 4 new admissions to the home since July 2006. A preadmission assessment visit had been made by the manager for each of these people and a needs assessment had been recorded. These assessments contained lots of detail about residents and their wants, needs and choices were clearly recorded. This is good for the residents. In addition, one resident’s’ relative talked about the assessment visit made by the manager and deputy managers in their questionnaire. Where possible, the residents’ next of kin had signed their relative’s assessment to confirm that they agreed with it. The manager explained that when residents are able to, they are encouraged to sign the assessment personally. Residents at the home did not have contracts at the time of inspection. The manager agreed that residents would benefit from having a clear contract concerning their stay at the home. It was strongly recommended that contracts were provided. The home does not provide intermediate care, therefore Standard 6 was not relevant. Holmfield DS0000067934.V319303.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the home’s practices were good. This included managing residents’ medication well, having a strong focus on residents’ choices and rights and ensuring that care could be given to each individual resident in the way they preferred. However, not consistently acting on important information about changes in need in the residents’ day-to-day records and updating the care plan accordingly had the potential to put residents at risk. EVIDENCE: Five care plans were sampled. Overall, care plans were clear and detailed and described the way the care needed to be given to meet the needs of each individual resident. In particular, care plans which demonstrated that the resident’s individual preferences had been taken into account included one that noted that a resident preferred a shower to a bath and another which noted that a resident preferred to wear a “shirt and tie each day”. The manager had introduced monthly reviews of the care plans. However, these were not in place for all residents. In addition, when looking at residents’
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 13 day to day records, it became obvious that some crucial information, which could have an impact on residents health and safety, had been recorded on the day to day records, but had not informed a change to the plan of care or triggered an investigation into the circumstances around an event. Examples included night staff finding a resident in a state of undress in another resident’s room and a resident expressing suicidal thoughts to night staff. The manager responded in a very proactive and professional manner to this feedback. She agreed that the communication and staff handover system at the home needed to be reviewed to ensure that managers and the staff team are aware of any important issues recorded so that action can be taken to address them without delay. A more user-friendly system was discussed and the manager said that this issue would be discussed with the staff team and addressed immediately. A requirement was made about this. Risk assessments were in place for some aspects of care. These included the risk of falls, wandering and moving and handling. Advice was given about extending this good practice to the completion of risk assessments, linked to the care plans, which assessed all risks to individual residents and the regular review of these risk assessments. A requirement was made about this. Residents’ files contained information about likes and dislikes and some individual needs concerning nutrition. Residents were also being weighed every month. However, the need for each resident to have a nutritional assessment and for control measures to be identified when a resident is at risk through low body weight was discussed. One example was a resident whose weight had dropped from 7 stone 3 lb to 6 stone 5lb in 5 months. The manager agreed that this needed looking into. Advice was given about information on the CSCI website about this and other issues concerning residents’ care. The manager was proactive in downloading this at the time of inspection and said that she would implement it as soon as possible. A requirement was made about this. Residents spoken to said that they were treated with respect and that their rights were respected. Residents’ relatives who completed questionnaires also were very positive about the way the staff treated the residents. Comments included the view of one resident’s relative who said that all residents were “treated with dignity and respect and everything possible is done to make their lives as pleasurable as possible” Care plans also reflected residents’ rights and choices. This is good for the residents. Medication was dispensed from a monitored dosage system. Medication records were seen and a high level of accuracy was noted. Staff training in the care of medicines was about to commence on 27/11/06. The course was provided by an accredited trainer and was a 12-week course, with weekly visits by the trainer throughout the 12 weeks and included assessing the competency of staff. There were no controlled drugs in use at the time of the visit. A controlled drugs record book was available should it be needed. The home was in the process of reviewing the storage of controlled drugs by
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 14 considering purchasing a controlled drugs cupboard. Interim arrangements were in place should controlled drugs need to be stored. A lockable medication fridge had been purchased since the home was purchased and the records of receipt and disposal of medication were detailed and well kept. Care plans had been put in place for individual residents concerning the administration of medication. This had been done in response to an incident reported by the home to the Commission concerning the administration of medication to one resident. These care plans stressed the need to respect residents’ choices and provided guidance on action to be taken if a resident refused to take prescribed medication This allowed staff to have a good knowledge of each individual resident’s needs, which is good for the residents. Holmfield DS0000067934.V319303.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents benefitted from their social, cultural and religious needs being well met, the home providing a wide range of activities and having a balanced and nutritious diet with choices. EVIDENCE: The home has an open visiting policy and residents said that their visitors were made welcome. Residents and their relatives were pleased with the range of activities. One relatives’ questionnaire noted that the home “lists the activities in the home each week and visitors are welcome to attend any they wish”. This relative made reference to activities outside the home, including a trip to Blackpool, that they could attend. Another relative said that activities are “very good and stimulating”. The home had introduced a newsletter. This detailed all planned activities including weekly craft sessions referred to as “ageing well” sessions. Other activities included weekly in house musical entertainers, Tai Chi and trips in the Age Concern mini bus to Blackpool, local shops and a market. Local schoolchildren had recently been welcomed into the home with gifts from the
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 16 harvest festival. A senior manager said that the home is working in partnership with the Library Theatre to enable a creative therapist to visit the home to help residents who want to become involved in creative writing. One resident’s relative talked about a theatre trip her mother had enjoyed. One resident was completing a mosaic she had started the previous week in the craft sessions. This person’s relative encouraged this person to take part in these sessions. Staff were also seen to encourage residents to take part and residents’ assessments and care plans detailed their social needs. Photographs of residents enjoying activities were published in the newsletter. Residents and one relative said that they liked the newsletter and the manager felt that it would be a good way of communicating with residents and relatives in the period of change that the home was experiencing since the purchase of the home. The newsletter detailed lots of improvements made to the home and thanked residents for their patience while a new fire alarm and emergency call system was being fitted. All of the residents at the home are White British, with the exception of one resident who is White British and is also Jewish. The manager said that the Jewish Federation supported the home to meet this resident’s social and cultural needs. The manager said that the local Roman Catholic Church provides Holy Communion for the Roman Catholics at the home every Sunday and that the minister from the local Church of England Church visits the home every month. Residents and one resident’s relative confirmed this. The manager talked about how the home addresses diversity. She said that wants, needs and requirements are dealt with at the assessment stage, including cultural needs, food, social needs etc. She said that eight of the residents are wheelchair users and the home endeavours to ensure that their access requirements are met. The inspector interviewed the cook, who was very enthusiastic about the positive changes to his work. He talked about the fact that he had been given responsibility for ordering food, that the menus had been reviewed to give a wider range of food and to include daily alternative choices. He said that since being given responsibility for serving meals, he had daily contact with residents and was able to discuss and observe likes and dislikes so he could meet needs and choices. The inspector saw the lunchtime meal being served by the cook and staff. The meal was hot and well presented and there were sufficient staff to help residents who needed help. Menus were seen and a balanced and nutritious diet was offered. Residents said that the food is good. Overall, residents’ relatives were also positive about food including one relative whose questionnaire noted that the meals were “first class- a varied menu and a good choice….My mother enjoys every meal and looks forward to them”. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefited from staff being aware of the complaints procedure, but needed to have easy access to a clear complaints procedure. The imminent staff training in implementing the adult protection procedure will increase staff awareness of the risks to residents and will therefore benefit staff and residents. EVIDENCE: The home has a complaints procedure in the staff handbook. Four of the residents’ relatives who completed a questionnaire said that they always knew how to make a complaint, but the other 2 were unsure. Residents spoken to had not seen a written complaints procedure. The manager agreed that the home needed to make a complaints procedure readily available to residents. A requirement was made about this. The home had a file to record complaints and compliments made. Just prior to the inspection the Commission was informed of an allegation of abuse and the home had acted in accordance with Manchester Social Service’s Policy on the Protection of Adults from Abuse. Training for all staff in the protection of adults from abuse had been arranged for 28/11/06. A senior Age Concern Manager, who had received training from “Action on Elder Abuse”, was providing this course. The specific requirements of Manchester Social Service’s Policy on the Protection of Adults from Abuse had been incorporated into the training for the benefit of all staff.
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the home was clean, comfortable and homely and the provider had made significant improvements, which enhanced residents’ safety. Further more long term plans to upgrade the home and short term plans to complete outstanding safety checks are necessary to further promote residents’ wellbeing. EVIDENCE: A partial tour of the premises was made. This included seeing communal areas, bathrooms, toilets and some residents’ bedrooms. Four of the 6 residents’ relatives who completed questionnaires said that the home was always fresh and clean. One relative talked about the need for more cleaning of bedrooms and said that there is a smell of urine. There were no smells of urine noted at the time of inspection, but the manager discussed the fact that the home had to work hard to reduce such smells.
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 19 One relative talked about the need for the home to be “modernised”. The manager and senior manager described recent positive changes made by Age Concern, which were costly. This included replacing the fire alarm system and the emergency call system. Some rewiring and some redecoration had been done and the manager said that Age Concern were committed to long term plans to update and improve the environment for residents. It was agreed that the home needed to conduct an audit to plan and prioritise improvements and a requirement was made about this. Examples discussed included the need to replace the hot trolley for food, upgrade the kitchen and replace some flooring in bathrooms and bedrooms. The manager said that Age Concern planned major redecoration in the next 2 years and the replacement of carpets. One resident’s relative said that “even with some work being done…..everything is kept neat, tidy and clean, with no inconvenience to the residents”. Some radiators at the home, including some bedroom radiators, were hot when touched and could put residents at risk of burns. The need to complete risk assessments concerning these radiators and to cover these radiators or fit control valves to limit the surface temperature where necessary was discussed. A requirement was made about this. The manager said that a quote had been sought to have all radiators covered. At the time of the visit, one fire door did not close properly into its rebate. The manager said that she would contact the Fire Service to request an inspection of the premises to ensure that all fire doors were safe. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Age Concern had significantly improved recruitment and selection procedures at the home, which enhanced residents’ health and wellbeing. EVIDENCE: The home had a staff rota and staffing levels appeared to be appropriate to the number of residents at the home. Three of the residents’ relative who completed questionnaires said that staff were always available when you needed them and the other 3 said that they usually were. Some residents’ relatives said that the home needed more staff, but most of the relatives spoke highly of the staff describing them as “fantastic”, “wonderful” and “always help when I ask”. One relative said that staff “go out of their way to help me”. One relative said that staff could be asked for help “at any time, night or day. This relative added, “ If I ring up during the evening, someone is always there to answer my questions”. Residents also said that the staff were good and that they received the help they needed. All encounters between staff and residents were seen to be positive. This is good for residents and their relatives. Throughout the day there were four staff on duty plus a manager/senior member of staff. At night there were two staff on waking duty and a senior member of staff on call in case of emergency or three staff on waking duty. The home also employed other staff to undertake cooking and cleaning duties.
Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 21 Two staff files were seen and it was noted that Age Concern had significantly improved recruitment practice at the home. References were taken and CRB checks were being made consistently. Not starting staff on the basis of their POVA FIRST checks and awaiting the full CRB clearance could further improve this good practice. Some key information on staff files was held at the head office, but the manager agreed that, wherever possible, copies of this information would be held at the home Eight staff were interviewed, some in a group and some individually. All staff were very positive about receiving regular appraisals, good access to training and having a good relationship with the manager. Staff said that Age Concern had made many improvements, including improved activities for residents. Staff were pleased that they were able to take individual residents out shopping. One member of staff was pleased to have been selected to complete an activities training course. Staff stated that they had “more respect”, “better working conditions” and “more involvement” when managed by Age Concern. They also said that the manager “listens to you” and “trusts you”. This is good for the staff and the residents. Two newly recruited staff said that the management and staff team had welcomed them. They added that equal opportunities in the organisation were good and that they had not experienced any discrimination. Staff said that recent staff training included training in moving and handling, food hygiene and NVQ. Training records were held on staff files and training needs were assessed in appraisals. ). A recommendation was made about the need for 50 of staff to be qualified to NVQ Level 2. The 2 new staff interviewed said that they had completed an induction, but that they didn’t have a formal record of this. The home was about to introduce formal induction in accordance with the Skills for Care Council (formally TOPPS). A recommendation was made about this. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager was working hard to support and supervise staff and to ensure that residents’ rights and health and safety were prioritised. However, the home needed to extend this good practice to include a fire risk assessment to promote the health and safety of residents and staff. EVIDENCE: The manager has 8 years experience of managing services for older people. She has forwarded an application for registration with the Commission as manager of the home. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 23 The manager holds an NVQ Level 4 in Care and was studying towards the Registered Managers Award at the time of inspection. Residents and their relatives spoke highly of the manager. One resident’s relative said that she was “lovely” and that she always went round all the residents to chat with them every morning. This relative said that the manager takes an active role in residents’ entertainment and goes on social functions with the residents, including recent trips to the Theatre and Blackpool. Another relative, who completed a questionnaire, said that she can “speak to the manager and assistant manager, who always have time to listen”. This is good for the residents and their relatives. The home had begun to draft questionnaires with a view to establishing a quality assurance monitoring system, which included finding out the views of residents and their relatives/friends. The need for the home to take account of the views of residents and their relatives about how the home is run, what is good and what could be improved was discussed. A requirement was made about this. Most of the residents at the home were supported by their families to manage their personal finances. The home holds some money for residents’ purchases. Records of financial transactions made on behalf of residents were in place and receipts were held for transactions. Residents, and those relatives who expressed a view in a questionnaire, that they were satisfied with financial arrangements. The manager provided information in a pre-inspection questionnaire, which demonstrated that most of the health and safety checks were being made e.g. of the gas appliances. Those tests which had not yet been done, e.g. of the water heating check for compliance with Legionella, were being arranged. The home had not undertaken a fire risk assessment and this meant that staff were not familiar with the particular risks from fire in the building to enable them to minimise these risks. A requirement was made that this needed to be done urgently. Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 24 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 X X X X X 2 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 3 x 2 x 3 x x 2 Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15. (2) (b) 13. (4) (b) and (c) Requirement Care plans must be reviewed when residents’ needs change. Risk assessments must be in place to assess all risks applicable to an individual resident. These must be subject to consistent review to take account of any changes. Residents’ nutritional assessments must be detailed and clear and the home must also have recorded strategies where any concerns/risk about a resident’s weight exist. The home must provide a clear complaints procedure for residents and make it readily available to them. The home must complete risk assessments concerning exposed radiators with hot surface temperatures and to cover these radiators or fit control valves to limit the surface temperature where necessary.
DS0000067934.V319303.R01.S.doc Timescale for action 20/12/06 13. (4) (c) 2. OP16 22 20/12/06 3. OP25 13(4) 20/12/06 Holmfield Version 5.2 Page 26 4. OP38 23 (4) To ensure the safety of residents and staff the manager must undertake a fire risk assessment and make sure that this is a working tool, that all staff are familiar with, which is updated and reviewed in line with local fire officers guidance. 20/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP2 OP7 Good Practice Recommendations It is strongly recommended that the Statement of Purpose and Service Users’ Guide is made readily available to prospective and existing residents and their families. It is strongly recommended that all residents are provided with a contract which details the terms and conditions of their stay at the home. It is strongly recommended that the communication and staff handover system at the home is reviewed to ensure that managers and the staff team are aware of any important issues recorded so that action can be taken to address them without delay. It is strongly recommended that care plans be reviewed on a monthly basis. Is strongly recommended that the home conducts an audit of the premises, which highlights planned improvements and identifies priorities and timescales. A minimum of 50 of staff should be qualified to NVQ Level 2 and the home should ensure that formal induction is introduced in accordance with the Skills for Care Council It is strongly recommended that the home reviews and develops their quality assurance system to provide a verifiable method, which involves residents, to audit the service and report on the findings. It is strongly recommended that the home contact Manchester Fire Service to obtain the advice of a fire officer on the completion of a fire risk assessment for the home and the fit of fire doors. 4. 5. 6. 7. OP7 OP19 OP28 OP33 8. OP38 Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Holmfield DS0000067934.V319303.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
