Inspection on 18/10/05 for Holmhurst Care Home

This inspection was carried out on 18th October 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmhurst Care Home 12/09/07

Holmhurst Care Home 21/04/06

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

CARE HOME ADULTS 18-65 Holmhurst Care Home 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD Lead Inspector Chris Johnson Unannounced Inspection 18th October 2005 09:00 Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 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 Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 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 Adults 18-65. 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. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Holmhurst Care Home Address 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD 023 8034 8403 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) Mrs Susan Boyes Mrs Susan Boyes Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users are not to be accommodated below the age of 30 years Date of last inspection Brief Description of the Service: Holmhurst Care Home is a large family home, extended to provide accommodation for 20 service users. Accommodation is provided in a range of single and shared rooms on the ground and first floors. Communal space comprises a lounge and small dining room. The home is registered to accommodate service users aged 30 to 65 with mental health needs. The home is located in a quiet side street a few minutes walk from the centre of Portswood and is close to local amenities and public transport. The home has recently undergone a change of owner and manager. The new owner Mrs Susan Boyes is also responsible for the day-to-day management of the home. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 18th October 2005 over one day. The purpose of this visit was to carry out an inspection of the home and follow up on requirements made at previous inspections. Since the last inspection the home has undergone a change of ownership and management. The new manager assisted the inspector throughout the inspection. The findings of this report are based on a number of different sources of evidence including; a tour of the premises that included looking at service user’s bedrooms. Staff and care records were inspected and several residents were spoken with. Evidence was also obtained from questionnaires completed by some of the residents. As a result of this inspection several requirements were made and a letter of serious concern was sent to the provider. Timescales to take action to address requirements were discussed and agreed at the end of the inspection. What the service does well: What has improved since the last inspection? There has been an improvement in the overall standard of hygiene and level of cleanliness in the home. Residents commented that they were happier to live in a cleaner home. Improvements to the Physical environment are also underway and the new bathroom facilities and redecoration of bedrooms will make the home a more comfortable place to live in. Residents have a greater opportunity to take part in activities and have more choice regarding food and more opportunity to make decisions for themselves. One person commented, “The quality of life in the home has improved greatly, since Sue took over”. There is less emphasis on filling the home to capacity and therefore less chance that peoples’ needs will be overlooked or not met. A staff-training programme has been implemented and the manager has a good understanding of the areas in which the home needs to improve and is actively seeking to bring about change. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,5 There is far less emphasis on filling the home to capacity. This means that prospective service users are less likely to be placed inappropriately. This also benefits those living at the home, as they are far less likely to have to share a room with someone not of their choosing. EVIDENCE: There had not been any admissions to the home since the new owner had taken over. The home was only accommodating 15 residents and all of these had been admitted when the home was under the previous manager. The new manager demonstrated a good understanding of the importance of not admitting any further residents unless she was certain that they could meet the person’s needs. The manager said that she was not in a rush to fill the remaining bed spaces and this will prove beneficial to existing and future residents, as there is less likelihood of people being placed at the home inappropriately. Several prospective residents had visited the home enabling both the home and the person come to a decision as to whether the home was right for them. At the inspection of the home in July 2004 it was noted that information within residents contracts or terms and conditions was out of date and did not provide them with sufficient information about their rights. Although these had not been amended they were in the process of being reviewed and updated by the new manager. Residents identified at the last inspection as not being appropriately placed at the home had since moved on to more appropriate accommodation. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 9 Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 10 The opportunity for service users to make decisions for themselves is improving and there has been an improvement in the standard of care planning Confidentiality is at times compromised, due to poor practice. There remains plenty of scope for improvement to ensure that residents care needs are fully identified, recorded and met. EVIDENCE: The manager had commenced reviewing residents’ care plans as these were found to be very lacking at the inspection held in July 2004. There remains plenty of scope for improvement to ensure that residents care needs are fully identified, recorded and met. However two members of staff had recently attended support planning and key worker training to assist with this. Written plans were in place for residents at risk of self-harm and the manager was attending Care Planning Approach (CPA) meetings to ensure that care plans incorporated all identified needs. Residents are given more opportunity to make decisions for themselves than was reported at the last inspection. Residents spoken with said that they had front door keys and could come and go as they pleased. It was noted and brought to the manager’s attention that there were still some notices in Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 11 residents rooms informing them that they were not to access the kitchen at night. There remains a need to improve confidentiality. It was noticed that there were service users daily activities including personal care needs displayed in communal areas of the home. These were removed during the inspection. Whilst it was accepted that these had been put there by the previous manager the current manager was advised to check all other notices and to take action accordingly. Residents’ files are safely stored. However daily notes relating to each resident are not recorded separately. This caused difficulties during the inspection when a resident asked to see his notes and could not be shown them as they contained information relating to other residents. Residents did say that they could talk to staff in confidence. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 The opportunities for service users to engage in appropriate activities has improved and they are able to maintain relationships with family and friends. Service users are offered a greater choice and quality of food. Residents’ rights however are often not always respected due to restrictive practices. EVIDENCE: Residents told the inspector that they have the opportunity to take part in activities both inside and outside of the home. One person regularly attends a supported workshop and other residents said that they were being encouraged to get involved in voluntary work and join the library and to do sports. There has been an improvement in the level of activities made available to residents. Residents have had the opportunity to take part in arts and crafts and the manager had purchased materials to facilitate this. A Halloween party was planned and eight residents had recently been on holiday. Some residents do spend a considerable amount of the day without being occupied although this is partly through choice and possibly due to habit. Staff and the manager do spend time talking to residents and residents identified at the last inspection as Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 13 not being appropriately occupied or stimulated had since moved on to more appropriate accommodation. Visitors were seen to come and go during the inspection. Residents confirmed that their visitors were made to feel welcome and that there were not any restrictions on when they could visit. At present there is a small staff room that is not utilised and could be easily converted into a small lounge area where residents could receive their visitors in private. Rather than have to meet with them in communal areas or their own bedrooms. Residents said that staff did respect their privacy and residents spoken with said that they had a front door key. All residents spoken with commented that the standard and quality of the food had improved. One person commented “We have more brand named food, bigger portions and there is more choice for breakfast”. Residents did say that the kitchen was no longer locked during the daytime, however the situation at night has not improved. Night staff often go to sleep and lock the kitchen door. This restricts residents’ access and denies them of the right to get refreshments as and when required. Residents do not feel comfortable having to rouse staff and ask them for the key and therefore often have to go without. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Service users are afforded a satisfactory level of choice regarding how they structure their day and their health care needs are being adequately met. EVIDENCE: All residents spoken with said that they were free to choose the time that they got up and went to bed. One person said, “You can please yourself”. Residents considered that there was a more relaxed feeling within the home. Records showed that had access to a wide range of health care professionals such as community psychiatric nurses, continence advisors, chiropodists, dentists and GP’s. Residents confirmed this and said that support to attend appointments was there if needed. The storage of medication had been improved and the cabinet had been removed from the kitchen to a more appropriate area of the home as previously required. Where appropriate residents manage their own medication and those that do not were happy with the way that it was managed. The new manager had organised for several members of staff to take part in a ten-week training course in the safe handling of medication. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Systems are in place for service users to express their concerns and the manager is starting to make the home a safer place to live. Safety is however jeopardised by poor and negligent staff practices. EVIDENCE: One member of staff had been convicted of theft from a resident since the last inspection and was no longer working at the home. This had been prior to the new manager taking over the home and no further complaints or allegations had been made since. The manager was advised however that they should check and refer the staff member to the Protection of Vulnerable Adults list to ensure that they could not gain employment elsewhere working with vulnerable people in the future. Adult protection training was being implemented for staff. One resident said that they had a copy of the complaints procedure and were fully aware of their rights and felt that confident that they could speak to a senior staff member or the manager if they had any concerns. In general residents said that they felt safe in the home during the day. However the current practice of staff sleeping at night does not protect residents and residents said that they did not feel safe or looked after at night. Residents’ support needs do not reduce at night and their vulnerability and safety is being jeopardised by this practice. This was highlighted at a previous inspection and the Commission for Social Care Inspection considers this to be an issue of serious concern. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25 and 30 Standards of hygiene have vastly improved and progress is being made towards improving the physical environment of the home. EVIDENCE: The new manager had implemented several improvements to the physical environment in the short space of time that she had taken ownership of the home. All rooms had been thoroughly cleaned and residents commented on the improvement in the standard of hygiene. One bathroom was in the process of being completely refurbished and plans were in place to create a wet room in another bathroom. Some bedrooms had been redecorated and the manager was using the opportunity of having empty rooms to facilitate this. New carpets had been purchased and the manager had employed a maintenance person and a cleaner. Several members of staff had attended recently attended infection control training. The manager acknowledged that there was considerable scope for improvement to the physical environment and in discussion with her the inspector was satisfied that plans were in place to achieve this. Appliances are being gradually replaced and a new washing machine had been installed. Since in post the manager had completed an inventory of all residents’ rooms that included, the condition of furnishings, bedding and fixtures. This had Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 17 enabled her to establish and prioritise which items were most in need of replacement. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 A change of attitude is needed amongst some of the staff team to ensure that service users feel and remain safe at all times. Staff training is being implemented and this should benefit service users and staff in the long-term. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. EVIDENCE: When the home was purchased the existing staff team remained in post. Unfortunately staff have traditionally been poorly supervised and not well managed. A cultural change of attitude is needed amongst some of the staff team. As previously mentioned, residents informed the inspector that the night staff sleep on duty and that they did not feel comfortable rousing them. This is unacceptable practice as the current agreed level of care includes the provision of two waking staff at night. This leaves the home unsafe, restricts residents, leaves them feeling vulnerable and does not provide them with the level of support that they require. The new manager was aware of some of these issues and had recently sought the advice of an outside agency. A business training review of staff skills has been carried out and a comprehensive staff and management training programme has been implemented. The manager said that she aimed to embed a training culture within the staff team and up skill all members of staff. Alongside this seven members of staff are due to start NVQ level 2 training in Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 19 November. All staff are being issued with new staff handbooks that includes a code of conduct informing them of procedures, their rights and responsibilities. Residents did say that they had noticed a difference and that they got on well with the staff. One person commented, “The staff are more reliable and want to be more involved, people are happier”. An improvement is needed in staff recruitment procedures. Although only one member of staff had been employed since the manager had taken over the home it was found that this had not been carried out satisfactorily. There was no evidence that either a Criminal Records Bureau check or a check against the Protection of Vulnerable Adults list had been completed. Only one reference had been obtained and this was dated two months after the person had commenced working at the home. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,41 and 42 The manager has a good understanding of the areas in which the home needs to improve and is actively seeking to bring about change. The standard of record keeping is still quite low and does not fully protect those living and working at the home. EVIDENCE: All residents spoken with were in agreement that the new manager was approachable and spent time talking with them. This was observed to be the case during the inspection. One person commented, “The quality of life in the home has improved greatly, since Sue took over”. There is still plenty of room for improvement, however the new manager has started to implement changes for the good of those living at the home. As well as the improved training programme, outside support and advice was being sought to improve team dynamics, communication and to assist with the management of the staff team. At present the new manager does not appear to have the full support of the staff team, it is however anticipated that this will improve. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 21 Whilst records such as care plans were being kept and maintained securely there is a need to improve on some aspects of record keeping and reporting. The Commission for Social Care Inspection had not been informed that a burglary had taken place at the home the previous week, whereby a substantial sum of a service user’s money had been stolen. Although this had been reported to the police, the registered person is required to inform the Commission for Social Care Inspection without delay of any theft, burglary or accident in the care home. The manager was able to provide certificates, service contracts and records to demonstrate that some appliances and equipment had been regularly checked to ensure that they were in safe working order. However the homes fire fighting and fire detection equipment is not checked and tested frequently. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 2 Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 1 17 Standard No 31 32 33 34 35 36 Score X 2 2 1 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Holmhurst Care Home Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X 2 1 X DS0000062744.V252061.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? 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 2 3 Standard YA5 YA6 YA7 Regulation 5 (1) (c) 15 12 (2) Requirement All service users are to be issued with either a contract or terms and conditions. All care plans and associated risk assessments are to be reviewed and updated. That you review all notices around the home relating to restrictions placed on service users and remove as necessary. All information regarding service users must be handled and stored confidentially. Ensure that all service users have access to refreshments during the day and night. Timescale for action 18/11/05 18/11/05 18/11/05 4 5 YA10 YA16YA17 12 (4) (a) 16 (4) 18/11/05 19/10/05 6 7 YA23 YA33 13 (6) 18 (1) (a) 8 YA34 19 (1) (b) Schedule 2 You must ensure that residents 19/10/05 are safeguarded at all times. The manager must ensure that 19/10/05 previously agreed staffing levels are maintained throughout the night. The manager must ensure that 19/10/05 robust recruitment procedures are implemented and that all documentation including Criminal Records Bureau and Protection of Vulnerable Adults checks are completed and satisfactory DS0000062744.V252061.R01.S.doc Version 5.0 Page 24 Holmhurst Care Home 9 YA41 37 10 YA42 23 (4) (c) references are obtained prior to commencement of employment. As the registered person you are required to inform the Commission for Social Care Inspection without delay of any theft, burglary or accident in the care home. Regular testing of the fire detection and fire fighting equipment must take place. 19/10/05 19/10/05 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 YA15 Good Practice Recommendations That the staff room is converted into a small residents’ meeting room/ lounge. Holmhurst Care Home DS0000062744.V252061.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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. 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