Inspection on 31/07/07 for Holmfield

This inspection was carried out on 31st July 2007.

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

Holmfield 14/11/06

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 Holmfield 4 Darley Avenue West Didsbury Manchester M20 2XF Lead Inspector Val Bell Unannounced Inspection 31 July and 3 August 2007 10:00 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.V340393.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.V340393.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 F/P 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.V340393.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. 14th November 2006 Date of last inspection Brief Description of the Service: Holmfield Care Home is registered to provide personal care for up to 32 older people, although the home currently provides 3 double and 23 single bedrooms to accommodate 29 people. The service is owned and managed by Age Concern Manchester. 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 a gardener is employed to ensure that residents are able to enjoy the garden when the weather is good. Safe wheelchair access is provided at the back of the building. The home has 3 lounge areas. Visitors can see residents in privacy in their bedrooms or in the lounge areas. Bedrooms 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 £380:00 per week for a shared room and £395:00 per week for a single room. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection on 4th July 2007 and supporting information in the form of a self-assessment provided by the manager prior to a visit to the home. Site visits to the home form part of the overall inspection process and the lead inspector conducted two visits on 31st July and 3rd August 2007. The opportunity was taken to look at the core standards of the National Minimum Standards (NMS). This inspection will also be used to decide how often the home needs to be visited to make sure that the required standards are being met. During the visits time was spent with people living in the home and discussions were held with care staff, senior care staff, assistant managers the registered manager and two area managers for the organisation. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ is used to describe people whose knowledge about social care services comes directly from using a care service. Mrs Jennifer Turnock an Expert by Experience joined the inspector on the first site visit. Mrs Turnock spoke to residents, toured part of the building and observed resident and staff interactions, her comments and observations were fed back to the manager at the end of the inspection and part of the feed back is added to this report and can be identified in bold text. What the service does well: The registered manager was keen to develop a person-centred service and this was in evidence in the way residents’ preferences and wishes were taken into consideration during the assessment process. Several examples of good practice were found in the way residents’ privacy and dignity was promoted. Residents spoken to confirmed that staff are kind, caring and helpful. Commendations for best practice were made in relation to the stimulating activity programme and the quality of catering provided. Robust policies were in place to deal with complaints and to protect people from harm and staff had good awareness of the procedures to follow in these Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 6 areas. People living in the home were aware of who they should speak to if they had any concerns. Private and communal areas were clean and hygienic and no unpleasant odours were present on the two days visits to the home. It was reassuring that Age Concern’s senior management attended the second day of inspection and expressed a commitment to providing support in ensuring that the required improvements would be addressed. What has improved since the last inspection? What they could do better: Following a discussion with a district nurse it was found that the personal care needs of two of her patients were not being met. It became apparent from discussions with carers on duty that insufficient staff had been deployed to meet the assessed needs of the more dependent residents. Care plans did not detail the personal care tasks that district nurses had requested to be carried out. This placed the health and welfare of these two people at serious risk. It was also identified that care staff would benefit from further training in an awareness of the conditions associated with old age. In particular staff needed to develop skills in communicating with people suffering from cognitive and sensory impairments. By the time of the second days visit, staffing had been increased and care staff and the district nurse agreed that this had improved the situation. During the inspection the expert by experience observed an incident of concern. This related to the behaviour of two care staff while assisting a resident in the lounge. These care staff carried on a private conversation and were unaware of the distress the resident was experiencing in trying to transfer from her wheelchair into an armchair. This information was not shared with the home’s management until after the inspection visit, so it was not possible to deal with the incident when it occurred. However, such behaviour compromises residents’ rights to have their support needs met in a private and dignified way. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 7 Age Concern acknowledged that the home’s décor, furniture and fittings would benefit from being upgraded and this had been added to the maintenance and development programme. A recommendation was also made to fit a grab rail next to the patio doors to provide assistance to residents using this doorway. Health and safety shortfalls were identified as follows. A fire door was not closing fully into its rebate, a fire exit was blocked by furniture in the lounge and the ramp access and fire escape route was considered unsafe in the event of an evacuation due to moss growth. Improvements needed to be made to ensure that all pre-employment checks were carried out prior to confirming new staff in post. The registered manager must also make sure that if staff are dismissed as a result of suspicions or allegations of abuse that referrals are made to the Protection of Vulnerable Adults list. Good practice recommendations were made to provide double signatures in the records of residents’ personal spends and to update the fire risk assessment with details of designated smoking areas. Finally, the infection control policy should be reviewed to ensure that staff are following good practice guidance in this area. 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.V340393.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 Holmfield DS0000067934.V340393.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People admitted to the home can be confident that their needs will be thoroughly assessed and that their preferences and wishes will be taken into account during the process. EVIDENCE: Since the last inspection on 4th July 2007 the Statement of Purpose and Service User Guide had been reviewed and updated to include the required information. These documents provided people with sufficient information on which to make a decision on whether the home would be the right place for them to live. Information held for three people living in the home was examined for evidence that their needs had been assessed prior to moving into the home. Their needs had been comprehensively assessed and it was pleasing that this Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 10 had been achieved in a person-centred way by taking their preferences and wishes into account. The home did not offer an intermediate care service. Expert by experience findings: One person I spoke to said this was her second time at Holmfield. She had been for a month at first and was not sure if she was suited. She tried another home but knew immediately that the staff were not as caring or responsive to requests for assistance. Another resident had chosen the home because she had previously lived nearby and it was convenient for her former neighbours and family to visit. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 11 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. Shortfalls in care plans and the way some staff treat residents, places people living in the home at risk of not having their assessed needs met and their right to privacy and dignity to not be respected. EVIDENCE: At the recent random inspection it was identified that the way care plans had been developed demonstrated good practice in person-centred thinking. On the morning of this visit the inspector had the opportunity to discuss the quality of care provision with a district nurse. It was concerning to learn that two of the district nurses patients were not having their personal care needs met despite specific instructions having been communicated to senior staff on several occasions. The care plans for these two people had not been updated to inform care staff of the tasks they needed to undertake to comply with the district nurses instructions. For example, one person’s assessment of needs stated that staff must monitor for excessive weight gain. Records stated that this person had been weighed on 31/03/07 and 03/05/07 and in the Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 12 intervening period had gained 15 pounds in weight. There was no evidence of this person being weighed since 3rd May or that any action had been taken to monitor her dietary intake. The second person was not having his personal hygiene needs met according to the district nurses instructions and there was no mention of the district nursing input in his care plan. This placed the health and welfare of these two people at serious risk. On the second day’s visit a lengthy discussion was held with the registered manager and two members of Age Concern’s senior management team. It was encouraging that the managers accepted that there had been serious shortfalls and had taken action to address the situation by increasing the staffing and management support to ensure that the needs of people living in the home were being met. Following the visits to the home concerns were expressed by a relative of one of the residents referred to in this report. Initial enquiries revealed that action had been taken to request a re-assessment of this person’s needs. Consequently, appropriate action had been taken by seeking professional input to ensure that the risk to the welfare of this person was minimised. The inspector was also given an assurance by the registered manager that all care plans were being reviewed to ensure that they accurately reflected the current needs of people living in the home. Three requirements and one recommendation relating to the administration, recording and storage of medication had been made at the random inspection of this home on 4th July 2007. Due to the potential for serious risk to residents’ welfare the provider and registered manager attended a meeting with officers of the Commission following the random inspection to discuss the situation. It was pleasing to find at this inspection that the system for administering medication had been reviewed and all the outstanding shortfalls had been addressed. Two unrelated shortfalls were found during this inspection. Medication administered to one of the residents on the morning of this inspection had not been signed for and the balance of medication held for another resident did not agree with the records as stock left over from the previous month had not been added to the current balance of medication held. These omissions were minor and did not present a potential risk to the welfare of the residents concerned. Expert by Experience findings in relation to privacy and dignity; As lunch was ending a doctor visited and one of the residents was taken to his room for an examination in private. Staff were extremely busy on the day of our visit, there had been a crisis elsewhere in the home, but staff were attentive, carried out their duties efficiently, spoke to residents kindly and listened to them. One was busy spoonfeeding a resident in the lounge, patiently giving ample time for the food to be swallowed, but also keeping an eye open on other residents. Without a word, she put down the plate and spoon and came to me, taking a hot plate from my pudding and moving the dish nearer to me. She had seen me struggling. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 13 There was only one incident that worried me. After lunch a lady came to the chair next to me pushed by a carer in her wheelchair. Facing the chair she tried to push herself up into a standing position. After several minutes watching her struggle the carer gave her a halfhearted push forward with her attention divided between her duties and a conversation with another carer. When the lady dropped back into the chair exhausted, she was scolded, “What did you do that for?” Next time both girls pushed but carried on their conversation while the resident said quietly, “There isn’t enough room, my feet have stuck. I can’t move.” By this time she was on her feet but in real distress. She pushed the wheelchair towards the carers, shuffled round and said, “I can’t find where to put my hands. I can’t feel the chair behind me.” With a monumental effort she got into position and dropped in a heap on the armchair. She cried for some time but was not consoled and sat slumped on one side for the rest of the afternoon, apparently asleep. Three other residents that I spoke to were happy with their care. The observations of the Expert by Experience were not shared with the inspector until after the inspection. This meant that the home’s management were unable to address the alleged incident at the time of the visit. However, staff should be reminded that carrying on conversations while providing care and support compromises the resident’s right to have her needs met in a supportive, private and dignified way. Action must be taken to ensure that all staff respect the rights of people living in the home. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 14 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 excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are provided with healthy eating choices and a varied programme of stimulating and interesting activities. EVIDENCE: A regular programme of activities was provided for people living the home. During the assessment process people were asked about their interests and hobbies and the activity programme was designed to accommodate individuals’ wishes and preferences, wherever possible. It was pleasing to note that Age Concern had provided additional resources, such as an activity co-ordinator every Tuesday and accessible transport. The activity co-ordinator was present during the first days visit and he explained that he was currently involved in a project to produce life histories for each person living in the home. This person-centred approach was commended as an area of best practice. This will enable staff to pay particular consideration to meeting the needs of people that have dementia and other cognitive impairments. Residents’ family and friends were also being consulted on the development of life histories, which provided evidence that importance was placed on encouraging residents to maintain their personal relationships. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 15 On the second days visit the inspector joined three residents on a table for the lunchtime meal. The atmosphere was relaxed and residents were observed to engage in lively conversation with other people on their tables. Menus on the tables provided a choice of three different meals. The meals were attractively presented and comments from residents spoken to were positive about the quality of catering in the home. The kitchen and food stores were found to be clean and hygienic and food was appropriately labelled and stored. Fridge and freezer temperatures had been recorded consistently and cleaning schedules were up to date. The chef was enthusiastic about meeting residents’ dietary needs and it was evident that he used his knowledge creatively to produce special diets that maintained individuals’ health. It was particularly pleasing to read the detailed records he kept of feedback from regular discussions with individual people. This evidence of best practice was commended. Expert by Experience findings; On arrival at the home, I was met by a senior member of staff who was very welcoming. Lunch was in full flow in the crowded dining room. I inspected the notice board while I waited to be placed for lunch. The last inspection report was clearly seen low down where everyone could reach it. There were photos of residents in various surroundings and on a trip to Marple by minibus and a sail on ‘New Horizons’ a converted narrow boat for disabled people. The trip included a stop in Whaley Bridge to look around a craft workshop, shops and a café followed by the sail back to Marple. All found it enjoyable. Other activities advertised on the notice board included music for relaxation, a day of pampering such as manicures and pedicures. I was told that massage and other caring techniques would be introduced in the future. Thursdays are for getting out and about for shopping, visiting a local pub to relax in the beer garden or walks to a local park. Fridays are reserved for live music when a variety of musicians entertain the residents. Most Saturdays, residents spend time with visiting relatives and enjoy a film show later in the day. Board games are also available. Next Saturday a group of residents are going to watch a member of the home’s staff get married. Sunday is the day for prize bingo. One of the people I spoke to was teaching other residents to play draughts and dominoes although bridge had proved more difficult. This person was a keen bridge player and said she would love to continue this hobby. (The manager later confirmed that a suitable bridge club was being sought for this resident) Another resident said that she liked the activities and had enjoyed the narrow boat trip. She said that she had lived locally and enjoyed visits from her former neighbours and her relatives. Later on in the afternoon I observed a resident going for a walk with her carer in the direction of the shops. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 16 There was no room for me to join residents in the dining room. About eight people were having their lunch in the three lounge areas and a carer directed me to sit next to one of these residents, which involved some furniture moving. There were two choices for lunch main course, fish cakes and pork casserole and several alternatives to ginger sponge and custard, yoghurt or ice cream. Four vegetables with the main course were good and suited most residents. High tea offered a choice of soup or sandwiches followed by fruitcake. Drinks were available at any time. As I eat my main meal at night I ordered cheese and biscuits and a small portion of ginger sponge and custard and a glass of orange juice. Without question I was brought a plate of four large slices of tasty cheddar cheese, four cream crackers, a small dish of butter (not margarine) and a small dish of soft garlic cheese. This was garnished with onion slices, some tomato and lettuce and a large glass of very weak orange juice. However, on such a hot day I was glad of a long cool drink. The food was tasty, fresh and appetizing and nicely presented with attention to detail. The paper serviette came in handy. When my plates were collected I was asked if I didn’t like the menu. It was nice to be able to say how much I had enjoyed my food. I was not able to observe the residents eating or estimate their enthusiasm for the food, but several people said they enjoyed the food. Each round table seated three or four people making it possible to converse with each other easily. There was a large bowl of fruit, individual dishes and serviettes on a table in the lounge, which encouraged residents to help themselves. I saw this happen. Holmfield DS0000067934.V340393.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust policies and procedures are in place to address concerns and complaints and to afford protection to residents from harm. EVIDENCE: As mentioned in the Health and Personal Care section of this report a relative of a person living in this home had expressed concerns about the quality of care in the home. No other concerns or complaints had been received in relation to this service. Policies and procedures were in place for the protection of people living in the home and training records and conversations with staff on duty provided evidence that staff knew the correct procedure to take if abuse was alleged or suspected. Since the two visits made to the home a member of staff had been suspended pending investigation into an allegation that a resident had been pushed into a chair. This demonstrates that staff were vigilant in safeguarding the welfare of people living in the home. The correct reporting procedures were followed in this instance. Two earlier safeguarding adult referrals had been made to Manchester Social Services. One of these incidents must be reported to the Protection of Vulnerable Adults list. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 18 Expert by Experience findings; I think people make themselves and their needs understood and are taken seriously. One of the people I spoke to said she knew how to complain and felt safe in her surroundings. Another resident said she was happy with her care and felt she could ask for anything she required. A newly admitted resident that I talked to said that she found the carers very kind and obliging, but was inclined not to complain but, ‘sort things out for herself.’ However, she knew how to complain and who to speak to. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and safety shortfalls present within the home potentially place the welfare and safety of staff and people living in the home at risk. EVIDENCE: On the second days visit a tour of the building was undertaken to assess health and safety. Since purchasing the home twelve months ago the provider has invested capital expenditure in renewing major systems including the passenger lift, nurse call system, portable fire equipment and the electrical wiring. Bedroom carpets had been replaced as rooms were vacated and a planned redecoration program was in place. Age Concern acknowledges that some areas of the home would benefit from redecoration and refurbishment and a rolling programme had been developed to address this in priority order. Health and safety shortfalls were found as follows: Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 20 A fire door to one of the bedrooms was sticking on the carpet and not closing fully within its rebate. Toilet cleaner had been left unattended on a trolley in a corridor outside the downstairs toilets. This placed the safety and welfare of people living in the home at risk. Residents were encouraged to bring personal items in with them on admission and this was confirmed in the bedrooms visited. Private and communal areas were clean and hygienic and no unpleasant odours were detected. Expert by Experience findings; The entrance for wheelchairs was via a narrow ramp with a step and 90-degree turn through a half-open door into the lounge. On the way out, chairs were moved away to reveal the doorway, which again opened only half way. The outer door was a typical fire door with panic bar but I didn’t see a notice to this effect. There was moss all down the right side of the ramp causing the wheelchair wheels to skid. I would not feel confident that wheelchair residents or visitors would be quickly evacuated in an emergency. The moss could also potentially present a slipping hazard to people walking on the ramp. I found the décor in the dining and lounge areas tired and mismatched. Chairs looked comfortable but shabby and some were in need of repair. Bedside tables used by residents eating in the lounges were old and some had plain wood surfaces that would make them difficult to clean. Staff spoke of, ‘new furniture arriving any day now.’ Curtains in the lounges were not thick enough to keep out the light and cold and too thin to shade from the sun. Two pairs of new curtains were very pretty but poorly put together. One of the residents told me that she was looking forward to moving into a bigger room and she planned to have a telephone installed and some of her own furniture. Her son was visiting at the time and said he was emptying her house and asked her what items of furniture she wanted to keep. The staff joined in the discussion and offered to store any excess in the attic. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Failure to ensure that staff are appropriately trained places the health and welfare of some people living in the home at risk. EVIDENCE: On the first day of inspection the following staff were on duty; three care assistants, a senior care assistant, an assistant manager and the registered manager. Staff were extremely busy during the morning, assisting people to get up. A visiting district nurse complained that she needed a member of staff to assist with her patients, but nobody was available. By 11:50 care staff were still getting people out of bed, just prior to the midday meal being served. An assessment of the dependency levels of the people living in the home revealed that insufficient staff had been deployed to meet individuals’ assessed needs. Care staff told the inspector that they had come on duty at 07:00 and did not have a break until 13:30. One person said, “Some of the residents are very dependent and it takes two care staff about an hour to get them up, washed and dressed.” Care staff didn’t feel that the home’s management appreciated this. By the time of the second visit it was encouraging to note that an extra member of staff had been deployed to alleviate the problem and care staff told the inspector that this had made such a difference. Additionally, the district nurse confirmed that a care assistant had been made available to assist her Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 22 with her patients. A recommendation was made to ensure that people living in the home had up to date and accurate assessments of their needs. The personnel records for a recently employed member of staff were assessed along with training records belonging to two other members of staff. The file belonging to the new member of staff contained two written references and one verbal reference and evidence that a Criminal Record Bureau certificate had been obtained. However, there was no evidence of this person’s proof of address or identity. Additionally, a good practice recommendation was made to introduce induction programmes with new staff that include the specifications of Skills for Care Induction Programmes. This will provide the opportunity to monitor staff performance and confirm if they are competent in meeting the assessed needs of people living in the home. Two training folders provided evidence of training in safeguarding adults from abuse, moving and handling techniques, medication administration and fire safety and the two members of staff had achieved a National Vocational Qualification in care at level 2. People living in the home had a diverse range of needs including sensory loss and cognitive impairments, such as dementia. Conversations with visiting district nurses provided evidence that two people with diverse needs were not having their personal care needs met at the time of this inspection. Care staff would benefit from additional training in cognitive and sensory impairments so that they can understand and respond appropriately to individuals’ assessed needs. Additionally, not all staff had been trained in safe moving and handling, although the manager confirmed that this was being arranged. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of people living in the home and their representatives are listened to and taken into consideration in planning improvements to the service. EVIDENCE: Two requirements were made in this section at the random inspection on 4th July 2007. One of these requirements had been addressed by the area manager completing monthly reports on the conduct of the care home. The second requirement relating to performance monitoring of the senior team remained outstanding. Satisfactions surveys had been issued to residents and their relatives on a sixmonthly basis. Feedback from the most recent survey included the following Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 24 comments, “I think Holmfield and all the staff do a fantastic job – thank you all” and “Staff are most friendly and accommodating and go out of their way to help in whatever way they can.” The manager said that future surveys would include the views of health and social care professionals visiting the home. As part of the quality assurance process residents and their relatives are invited to meet every three months. Age Concern’s Counselling Manager chairs the meetings and minutes of the most recent meeting on 25th April 2007 were shown to the inspector. Issues discussed included activities, building maintenance, staffing, training and the use of volunteers. This is an example of good practice. Appropriate facilities were available for the safekeeping of residents’ personal spending money. Bedrooms had been fitted with secure storage facilities and for people that needed assistance with their personal spending money there was the option of depositing this in the home’s safe. Up to date records were held of the balances held on behalf of residents and three of these balances were checked and found to be correct. A good practice recommendation was made to obtain two signatures for all credit and debit transactions. A sample of health and safety records was examined including fire safety, gas equipment maintenance and the security and safe use of hazardous substances such as cleaning materials. These records were found to be accurate and up to date. One of the resident’s had been risk assessed as being able to smoke safely in his bedroom. The home’s fire risk assessment should be updated to include this information. Expert by Experience findings; I was not asked if I wanted to wash my hands before of after lunch and I did not see evidence of spirit cleansers for visitors, residents or staff. The manager later confirmed that spirit cleanser was provided. Staff should be reminded to point this out to people visiting the home. A member of staff disposed a plastic apron in an open rubbish bin in the lounge. Personal protective equipment should be disposed of safely to prevent contamination and cross-infection. After lunch residents were doing their own thing. A resident’s husband visited and he helped his wife to the patio doors and out into the sunshine. There was a small step and only the edge of the patio door to hang on to. The registered person should consider fitting a grab rail to enable people living in the home to mobilise safely and independently. Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 25 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Timescale for action Care plans must accurately detail 04/09/07 the personal care tasks to be undertaken as determined by up to date assessments of residents’ needs. Remains outstanding from the previous inspection. Action must be taken to ensure that staff are assisted to develop and maintain respectful relationships that do not compromise the privacy and dignity of people living in the home. The registered manager must make a referral to the Protection of Vulnerable Adults list for any member of staff that has been suspended or dismissed pending an allegation or suspicion of abusing a resident. The registered manager must take action to keep residents safe from: 1. The risk of smoke inhalation in the event of a DS0000067934.V340393.R01.S.doc Requirement 2. OP10 12 (4) and (5) 04/09/07 3. OP18 13 (6) 04/09/07 4. OP19 13 (4) 04/09/07 Holmfield Version 5.2 Page 27 fire by ensuring that all fire doors are fully closing and that designated fire exits are free from obstacles and slipping or tripping hazards. 2. The risk of harm from substances hazardous to the residents’ health, such as cleaning products. 5. OP27 18 Staff must be deployed in sufficient numbers at all times to meet the assessed and changing needs of people living in the home. The registered manager must not employ any person to work in the home until the required pre-employment checks have been obtained. The manager must submit an action plan to the Commission detailing how the performance of the senior team will be monitored, appraised and their competency assessed. Taking this action will afford protection to the welfare and safety of people living in the home. 04/09/07 6. OP29 19 04/09/07 7. OP31 18 (2) 04/09/07 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 OP8 Good Practice Recommendations The registered manager should ensure that district nurses instructions for the care of their patients living in the home are recorded in care plans to ensure that residents’ health DS0000067934.V340393.R01.S.doc Version 5.2 Page 28 Holmfield 2. OP8 and personal care needs are met. Residents weight should be monitored as indicated in their assessments of need to ensure that their health is maintained. The registered manager should ensure that medication records are accurate and up to date in the best interests of the residents’ health and welfare. The registered manager should ensure that staff have read and understand the behaviour that is expected of them in line with the General Social Care Council Codes of Conduct for Care Workers. Décor, furniture and fittings within the home should be brought up to acceptable standards in the best interests of people living there. The registered manager should ensure that formal induction is introduced in accordance with the Skills for Care Council Induction Standards. The registered manager should ensure that staff have the necessary skills and knowledge in moving and handling and cognitive and sensory impairments in order for staff to competently meet the assessed needs of residents. The registered manager should consider developing the quality assurance programme by surveying the views of health and social care professionals visiting the home. Financial transactions undertaken on behalf of residents should be witnessed by a second person to safeguard the financial interests of people that need assistance with their personal spending money. The registered manager should update the fire risk assessment to state that one of the bedrooms is a designated smoking area. Additionally, infection control procedures should be reviewed to ensure that staff are following good practice guidelines in this area. The registered manager should consider fitting a grab rail next to the patio doors in the best interests of the residents’ safety. 3. OP9 4. OP10 5. OP19 6. OP28 7. OP28 8. OP33 9. OP35 10. OP38 11. OP38 Holmfield DS0000067934.V340393.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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.V340393.R01.S.doc Version 5.2 Page 30 - 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. 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