Inspection on 29/04/08 for Holmlea Care Home

This inspection was carried out on 29th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holmlea Care Home 15/05/07

Holmlea Care Home 15/06/06

Holmlea Care Home 24/10/05

Holmlea Care Home 21/10/04

Holmlea Care Home 27/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Holmlea Care Home Waverley Street Tibshelf Derbyshire DE55 5PS Lead Inspector Jill Wells Unannounced Inspection 29th April 2008 09:30 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 Holmlea Care Home DS0000035767.V363317.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. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmlea Care Home Address Waverley Street Tibshelf Derbyshire DE55 5PS 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) 01773 728600 01773 728605 pat.rhodes@derbyshire.gov.uk www.derbyshire.gov.uk Derbyshire County Council Patricia Ann Rhodes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2007 Brief Description of the Service: Holmlea is situated near to the centre of the village of Tibshelf and is next to the local medical centre and pharmacy. The home provides 24 hour personal care and accommodation for 40 older people. The home is a purpose built, single storey building and all residents have single rooms. The design of the home is four separate wings. The home has pleasant garden and patio areas fully accessible to residents. Derbyshire County Council owns the home. Fees are £392.18 per week for permanent residents, but people staying for short term care are individually assessed. Additional charges, e.g. hairdressing, chiropody, are clearly identified in the home’s Statement of Purpose and Service User Guide. Copies of inspection reports are available in the foyer. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. The inspection visit was unannounced and took place over 8 hours. There were 32 people living at the home on the day of the inspection which included people staying for day care and respite care. 5 residents, 7 staff, 1 visitors and the service manager responsible for the home were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 15th May 2007. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the service does well: Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 6 Where possible people were encouraged to come for a full days of assessment as a minimum in order to see whether the home can meet their needs and if they wish to return to the home for a longer period of time.A person recently admitted to the home was spoken with and said that, I have not been here long, but it seems lovely . The activities co-ordinator worked hard to ensure that activities offered were what people wanted, varied and stimulating. Having a student on placement at the home had benefited several residents who had received one-to-one attention. The home was clean and fresh and well maintained. People at the home were particularly proud of the garden area, as this had won competitions. The food was of good quality, using fresh fruit and vegetables. There was a choice at each meal time and people living at the home were very satisfied with meals provided. One person said that, the meals are always very good. Several speak people spoken with commented on how friendly and homely Holmlea was, one person wrote in their survey that, we are always made to feel welcome. Several comments were received concerning how caring staff were. One person said that, the staff are wonderful, some are angels. Another comment was that, although staff are very busy they care for people well. Holmlea was well supported by the service manager who was responsible for the home. This person made visits regularly and monthly reports were written on all aspects of the service. What has improved since the last inspection? What they could do better: The medication systems were not safe and several errors were found during the inspection visit. Personal service plans for people living at the home were not always up to date, sometimes with vital information missing. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 7 One person with particularly challenging behaviour was not being responded to well, and there was not a management plan in place to help staff to deal with this behaviour. Written and verbal communication systems could be improved, particularly between the management team and staff team. There was evidence that lack of communication had reduced the quality of some peoples care. There was a high turnover of people staying at the home with a number of respite people being cared for as well as people in for an assessment period. Care staff were not being provided with sufficient information about these people to ensure that they could provide a good quality of care. All staff that were spoken with were unhappy about the amount of time that they felt able to spend with people. Care staff felt that they had a high proportion of domestic tasks including washing, ironing, mending, and making beds that took time away from people living at the home. Staff member said that, Staff are stretched at Holmlea, there are too many tasks and also the needs have changed with some of the residents, making them more dependent. 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. Holmlea Care Home DS0000035767.V363317.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 Holmlea Care Home DS0000035767.V363317.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): 1,3,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. EVIDENCE: The statement of purpose and service user guide were available for prospective people wishing to live at the home. Minor information was not correct within these documents for example, the new contact details of the Commission for Social Care Inspection (CSCI) and information concerning fees were not included. The service user guide was available in each persons bedroom. We were told that the manager or a deputy manager visits prospective residents at their home or in hospital as part of the assessment process. Prospective residents or their family and friends were encouraged to visit prior Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 10 to making a decision about whether the home will meet their needs. A full day assessment was actively encouraged unless there was an emergency situation, to ensure the suitability of the placement and that the person is making an informed choice. A person recently admitted to the home was spoken with and said that, I have not been here long, but it seems lovely . Information provided by the service in our annual quality assurance assessment (AQAA) was that all prospective residents had a comprehensive assessment of their needs completed by a care manager and a letter is issued to confirm the arrangements for care. From discussion with people living at the home many had visited the home for several periods of respite care or to access day services before they made decision to move permanently to the home. This meant that staff often knew them well and they would also know people already living at the home, which was beneficial for everyone. Copies of assessments were in place on the 3 peoples records that were seen. A care manager completed these. They were detailed and included information concerning each persons health and personal care needs, social interests, relevant history and care and family involvement. The service provides intermediate care, although they prefer to use the term assessment beds, for up to 2 people, This is a pilot using the intermediate care team to support each individual to gain their independence with a view to returning home, usually after a hospital admission. The service manager reported a high percentage of people successfully returned home. Holmlea Care Home DS0000035767.V363317.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): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current practice of recording medication may put people who use the service at risk. Lack of robust systems including communication had reduced the ability for staff to provide good quality care. EVIDENCE: The care records of three people living at the home were seen. They were person centred and included peoples preferences. They were written in plain language, and were easy to understand. Individual records also included moving and handling plans, falls risk assessment, nutritional assessment, a record of weight, and tissue viability risk trigger tools. Not all care plans that were seen were up to date. For example one person had been displaying challenging behaviour for approximately 4 weeks. There was no information concerning this behaviour or how staff should manage the behaviour. There Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 12 was also no indication as to how the home were minimising distress for other residents and visitors. A care worker was spoken with and said that they were involved with peoples care plans and could give details of individual care required. The key worker for each person was expected to write a monthly review, involving the person. Record showed that most were fairly up-to-date although some had not been written on a monthly basis and one that was seen had not been reviewed for 4 months. Staff said that this was because they were often too busy. One person admitted to the home the day before for respite care had information about their care needs provided by a care manager on the computer system but neither the person in charge or care staff were aware of anything about the person’s care needs when asked. Staff said that when new people came into the home information was usually available in the staff room for them to read. This was not a secure place, and did not ensure safe record storage and confidentiality. The home was moving towards a system where information concerning each person was on the computer system. This was not accessible to care staff and a reliable system had not been devised to ensure that staff have access to this information. The system for recording people’s contact with their GPs was to record in the managers’ communication book, then transfers this information to a ‘GP book’ on a weekly basis. There was not a record of GP visits in individual files. One record concerning a visit to the GP due to a person’s challenging behaviour only stated what medication had been prescribed, not the reason for the visit or advice given by the GP. Several staff said that when they had advised a manager that a person was poorly and needed a GP, this request was not always responded to. One person was returning after a stay in hospital, and due to lack of communication the equipment that they needed for their pressure care had been returned by staff as not required before she came back to the home. A district nurse called during the inspection visit. They explained that this person had sore areas as a result of lack of equipment and equipment was being reordered as a matter of urgency . Staff spoken with were concerned that there was a high importance placed on undertaking domestic tasks, at times prioritising this over spending time with people living at the home. Medication in the home was stored securely. Either the manager or a deputy manager administered medication. Information provided was that they had all received medication training. There were significant errors on the medication administration records. Examples were several peoples medication had been removed but not signed as administered, one persons medication had been signed as given but was Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 13 still in the monitored dosage system. One person’s medication was signed as given twice on the medication administration records, but three times in the controlled drugs register. There were not sufficiently robust medication systems for people coming to the home for respite care. For example there were no photos in place to ensure that the person administering the medication could check that it was being given to the correct person, handwritten medication records were sometimes but not always countersigned to evidence that checks had been made. When people came in with their own medication there was not a record of the quantity of medication brought in. This meant that if any errors occurred, a check could not be made of how much medication had been given. One person that had been admitted for respite care had brought in 4 items of medication, but there were only three recorded on the medication administration records. The person writing this record had not asked a second person to check the information. Controlled drugs were securely stored and the controlled drugs register was checked and found to be accurate. There was a locked fridge for medication that required refrigeration. Care records showed that individuals had been assessed or asked if they were able to self medicate. Information provided on our annual quality assurance assessment was that pharmacy audits were completed quarterly. Holmlea Care Home DS0000035767.V363317.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 good. This judgement has been made using available evidence including a visit to this service. The range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home. EVIDENCE: The last inspection visit on 15 May 2007 found that the home provided suitable activities and the quality of catering was good. Information provided by the service in the annual quality assurance assessment was that people chose how they wished to spend their time including use of their rooms. Key workers and the activities co-ordinator encouraged residents to take an active part in planning their daily life and social activities. There was recorded evidence of a wide range of activities that people could be involved with. This included bingo, chair based keep fit, cookery, sewing, Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 15 crafts, gardening and manicures. An activities co-ordinator worked for 3 hours per day Monday-Friday. On the day of the inspection visit there was bingo taking place. Several people spoken with said that this was their favourite activity. Records were kept of activities offered and included the names of people that had been involved. There were trips organised on a monthly basis using community transport. This was usually a drive around Derbyshire and a meal. Staff said that they were often limited whom they could take due to relying on volunteers to help. At the time of the inspection visit a student was on placement at the home. The student said that she was mainly working with three people, doing life story and reminiscence work. She was also helping the activities co-ordinator and supporting people to be involved in any activities that were planned. The students said that, I previously had very little knowledge of care homes but coming here does not seem like an institution the way I imagined it. She felt that people were very well looked after and the staff worked hard. Residents meetings were held on a 3-monthly basis. Minutes of these meetings showed that people were well consulted concerning trips out, entertainment and use of residents fund money. People living at the home had requested additional clocks and pictures for the home to be paid from the amenities fund. The manager told us that peoples religious needs were met with a Church of England service held monthly at the home. One person spoken with said that they enjoyed the singing. Staff told us that residents could go to bed and get up when they wished to do so, although pressure on staff sometimes meant that they could be less flexible. The conservatory was a designated smoking area. One person spoken with said that, I like to come in here and have a smoke, it is nice and quiet. People were encouraged to bring their own personal possessions with them and bedrooms that were seen were comfortable and had been personalised. There was a choice of food at mealtimes. On the day of the inspection the options were roast pork, potatoes and fresh vegetables or ham salad. Apple crumble or fruit with jelly, ice cream or fresh fruit followed this. Breakfast was a choice of grapefruit, prunes, porridge, cereal and a hot option that changed daily. All 10 people that returned surveys said that meals were good, and all the people that were spoken with said that the food was of a very good standard. One person living at the home said in our survey, Meals are very nice. One person spoken with said that, food here cant be beaten. The cook was spoken with. They said that she had attended a training course on nutrition for the elderly and tried to put her knowledge into practice. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 16 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. People who use the service are able to express their concerns and are protected from abuse. EVIDENCE: Information from the last inspection visit 15 May 2007 was that clear and accessible complaints and safeguarding adults procedures were in place to ensure residents could be confident that any issues raised would be acted on effectively and promptly. Information from the manager was that the complaints procedure was publicised and available in alternative formats if required. Information in the annual quality assurance assessment provided by the manager was that all comments and informal complaints were investigated promptly and resolved as soon as possible. As a result, the home has received no formal complaints since the last inspection. There was 1 verbal complaint recorded at the home since the last inspection visit. This had been resolved satisfactorily. The complaints procedure was displayed in the hall. This included the details of the Commission for Social Care Inspection (CSCI), however it had not been revised to include the new address and contact number. 6 of the 10 people living at the home that Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 17 returned our surveys said that they did not know how to make a complaint. People spoken with said that they would talk to staff if they had a complaint. In the hallway there was a, praise and grumble book which encouraged residents and visitors to complete. Although there were few entries in this book, all entries were praise for the home. The last entry said, thanks to all the lovely staff. Staff spoken with were aware of the whistleblowing policy and the importance of alerting someone to poor practice or possible abuse if they ever saw this. Training records were not available but care staff spoken with said that they had received training in safeguarding vulnerable adults. Holmlea Care Home DS0000035767.V363317.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): 19,20,21, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home is a purpose-built one-storey building. The home is divided into four colour coded wings. Each wing has a lounge/dining room, a small kitchenette 10 bedrooms, toilet and bathing facilities. There is also a large communal lounge and a conservatory that is used as a designated smoking area. A tour of the building showed that the home was clean and well maintained. All 10 surveys returned from people living at the home said that the home was always fresh and clean. People spoken with also said that they were happy with the level of cleanliness at the home. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 19 Information from the service was that new furniture for two lounge areas had been purchased, new carpets in the main lounge and in two bedrooms and improved lighting on the main corridor. A new hoist and new specialist bath had also been installed since the last inspection visit. Information from the manager was that further decoration of the home and replacement of carpets and furniture was planned and a quiet room was to be identified and equipped to improve facilities for people living at the home. Furniture had been delivered and was awaiting distribution around the home at the time of the inspection visit. There were sufficient numbers of bathrooms and toilets to meet peoples needs. There were grab rails and other aids around the home to assist people and maximise their independence. There was a small hairdressing room, and the hairdresser visited weekly. Laundry facilities were sited away from the main areas where food was stored and prepared. At the last residents meeting in February 08 it was brought up that clothing was often lost or given to the wrong person. People living at the home spoken with were unclear whether this had improved. Bedrooms that were seen were comfortable and homely. People had personalised their own room. One person said that, my room is lovely, very comfortable. One person wrote in their survey that they would prefer a larger bedroom. There was a public telephone available for people living at the home to use. The entrance hall now had a reception area. The admin worker usually sat here in the mornings, dealing with paperwork and any visitors. In the hallway there was information displayed including the last inspection report, minutes of residents meetings and future events. Holmlea Care Home DS0000035767.V363317.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): 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. The staff training programme was good and ensured that people were protected by competent, well-trained staff. Staffing levels may not meet the needs of the people using the service. EVIDENCE: Information from the last inspection visit 15 May 2007 was that, A trained and competent workforce was in place which generally met the dependency needs of residents currently accommodated within the home. Information from our annual quality assurance assessment provided by the manager was that staffing was provided to meet the needs of residents and the mix of short-term residents was monitored to ensure that the home could meet their needs and additional staffing was authorised if required. On the day of the inspection visit there was a relief manager and 4 care assistants on duty, as well as the cook. The duty rota showed that this was usually the case Mon-Fri, however at weekends staffing levels were reduced. The service manager who was present for some of the inspection visit Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 21 explained that the reason for this was that staff did not need to take people for appointments at the weekend, activities were not usually planned and less bathing was offered. Also visitors were more frequent and would sometimes take residents out. There were 3 people living at the home, which included 1 person staying for respite care and 2 for day care. Information previously provided by the manager was that there were 3 people living at the home that required 2 staff to help with their care and 5 people that needed help or supervision to eat their meals. 19 people required help with dressing/undressing and 13 people needed help going to the toilet. It was evident from observations that staff were very busy. 10 surveys were returned from people living at the home. 9 people said that they received the care and support that they needed and one person said that they sometimes did. 7 people said that staff were usually available when needed and 3 said that they were only sometimes available. One person wrote on our survey in response to the question concerning staff availability when needed, no because they are often busy with other people. A staff member wrote on our survey, Never enough time to give one to one with residents as there are to many jobs to be done. Another comment was, Staff are stretched at Holmlea, there are too many tasks and also the needs have changed with some of the residents, making them more dependent. Care staff had several non-care tasks that included washing, ironing, mending clothes, making beds, hoovering after mealtimes and washing commodes. This took time away from providing direct care to people living at the home. One care worker said that, we feel like glorified domestics. Seven staff were spoken with during their hand over period. All were concerned about the lack of time that they could spend with residents. One person said that, we dont have time to just sit and talk to residents, not even for five minutes. They thought that this was due to the high number of domestic tasks, particularly the laundry ,as well as the high dependency levels of some people living at the home. One person said that, I feel like I am constantly saying to people, wait a minute. Staff said that they thought that the workload and stress were affecting staff morale and contributing to high sickness levels. It also affected their ability to be flexible concerning peoples needs. Staff felt that the high turnover of people coming to the home for respite, assessment, and day-care was a factor that increased workload but was not being sufficiently taken into account. The district nurse that visited the home said that there were 5-6 people that had high dependency needs and felt that this was becoming difficult for staff. The district nurse also said that, Holmlea is an excellent home, and staff are very good. The service manager responsible for the home was spoken with at the time of the inspection visit about these concerns. Her view was that there were no residents living at the home that needed nursing care, and sickness levels had Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 22 improved over the last few months. However she was not aware of a formal assessment of dependency levels since September 2007. As a result of this discussion, the service manager contacted us the day after the inspection visit to say that they had suspended admissions to the home for a two-week period to allow them to assess dependency levels of the present people living at the home. Other information provided by the service manager after the visit was that 99 hours per week (14 hours per day), worked by deputy managers, had been included in the providers calculation of care hours. However during the inspection visit the deputy managers were seen providing very little direct care. Their duties were mainly office-based. At the last inspection visit recommendations were made. One was that Staffing levels should be reviewed so that the key worker role can be fulfilled and ‘one to one’ time spent with residents, which will benefit their quality of life. The second was that There should be formal recording of resident dependency levels monitored to ensure staffing levels meet residents’ assessed needs. The service manager explained that the staff rota and some shifts had been changed but no additional staff had been agreed as a result of this review. It was confirmed at the visit that dependency levels were not being regularly monitored, however this information was provided after the visit. Ongoing communication with the service manager after the inspection visit showed that the service manager, alongside the manager was actively looking at dependency levels of people at the home as well as staffing levels. Information provided by the manager was at the home applies all policies concerning recruitment, ensuring that all checks are done including a criminal record bureau check before starting. Staff files were not checked on this occasion. There was an induction programme in place that met the Skills for Care standards and included first aid, food hygiene, moving and handling, hoist training, dementia care, safeguarding adults and bereavement. A new person spoken with said that it was a thorough induction. Training records were not available as only the manager had access to these. The service manager explained an efficient system, that involved the training and development team alerting managers when staff needed training, including refreshers, and staff were automatically booked on the next available course. The service had achieved 70 of care staff with National Vocational Qualification level 2 Care, (NVQ), which was above the minimum requirement of 50 . Information provided was that 4 staff had left in the last 12 months, which shows a reasonably stable staff team. A relative that returned a survey said that, In our experience of Holmlea the staff are always aware that it is the residents home and do their best to create a comfortable and friendly atmosphere. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 23 Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were effective quality assurance systems, ensuring that people living at the home are listened to. Poor systems and communication between the management team and staff meant that the staff team were not always working in the best interests of people. EVIDENCE: The manager had completed the Registered Managers Award (RMA). Record showed that she had recently attended training on attendance management, Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 25 certificate in nutrition, health and safety for managers, risk management and accident reporting for managers. The service manager visits regularly in order to support the manager and complete monthly reports. The service manager was present during the afternoon of the inspection visit. At the time of the inspection visit there were relief managers covering both the morning on the afternoon shift. Our annual quality assurance assessment (AQAA) was well completed, providing all the information that was required. There were a number of ways that the manager ensured that people were given an opportunity to comment on the service. This included an annual survey sent out to people living at the home and their families. The most upto-date summary was made available. This explained that every person living at the home was invited to take part, supported by Age Concern if necessary. 100 of residents rated the overall service as either excellent or good. Access to health care, building comfort, and visiting arrangements were rated as 100 . Areas for improvement included the amount and variety of social activities offered, practical help and one-to-one time from staff and people being treated as an individual. Suggestions made included more choice at mealtimes, redecoration of the building, a mobile library and more time for staff to update relatives about the health needs of residents. An action plan was due to be completed as a result of this survey. Residents meetings were held to discuss how the home should be run, menus, outings, activities and entertainment. The minutes that were seen showed that people were asked if they would like any changes made. Information provided on our survey from a member of staff was that there was a lack of staff meetings and supervision. One worker that was spoken with said that they had only had two supervision meetings since she had started some time ago. Several staff members said that staff were not listened to enough by management. Records showed that the last staff meeting was September 2007. One staff member commented on a survey that handover between shifts varied depending on the person in charge. Sometimes there was only a written hand over report, whilst at other times there was a discussion, which gave the opportunity for questions. There was a general feeling amongst staff spoken with that the management and staff team do not work well together. Some staff also said that their judgment was not respected concerning residents. Some staff said that there was an, us and them culture with several of the management team seeming unapproachable. This was discussed with the service manager. She explained that a staff meeting had been arranged but was cancelled due to sickness. Ongoing communication with the service manager after the inspection visit was that management and staff meetings had been arranged as a result of this inspection visit. This showed a positive response to the findings of the visit. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 26 There was a good system to ensure the safety of residents’ money. This included clear records of any money that was held on behalf of the person by the service. There was evidence that these records were regularly checked. Regular health and safety checks were being done. This included testing water temperatures, call systems and fire equipment. A sample of test certificates were seen and found to be up to date. Chemicals were securely stored and staff spoken with were aware of relevant health and safety issues. Information received from the service was that all policies and procedures were in place and had been reviewed. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 27 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 2 3 3 Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 28 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. Standard OP9 Regulation 13(2) Requirement Medication that has not been given must not be signed for as given on the medication administration records to ensure safe systems for administering and recording of medication. The person administering must sign for medication that has been given on the medication administration records to ensure clear and safe recording. The medication administration records must match the controlled drugs register to ensure that errors do not occur. Handwritten medication administration records must be checked and countersigned by a second person to minimise the risk of errors. When new people admitted to the home bring in medication the quantity of medication that they have brought in must be recorded. This will ensure a clear audit trail and minimise risks. All care plans (personal service plans) must be up to date, DS0000035767.V363317.R01.S.doc Timescale for action 27/05/08 2. OP9 13(2) 27/05/08 3. OP9 13(2) 27/05/08 4. OP9 13(2) 27/05/08 5. OP9 13(2) 27/05/08 6. OP7 15(1)(b) (c) 27/07/08 Holmlea Care Home Version 5.2 Page 29 7. OP27 18(1) (a) accurate, and state the action that needs to be taken to meet individuals’ needs. This is to ensure that staff are aware of people’s up to date care needs. The care staff hours must be reviewed. This review needs to take into account the number of people living at the home and their dependency levels, respite and day-care as well as the number of hours care staff undertake domestic duties. This is to ensure that there is the correct level of staff working directly with people living at the home. 27/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations A photograph of new people being admitted to the home including people for respite and day-care should be available to ensure that staff administering medication can check that they are giving medication to the correct person. All care plans should be reviewed monthly and any changes reflected in the plan to ensure that staff are following the most up to date information. Any person with challenging behaviour should have a plan of how staff should manage this behaviour, which should be followed by care staff. This is to ensure that the persons needs are met in a safe way with minimum disruption to other people. Staff on duty should be aware of the needs of new people admitted to the home in order to ensure that the right care is given. The systems for written/verbal communication should be reviewed to ensure that effective communication between the management and the care team takes place in order to DS0000035767.V363317.R01.S.doc Version 5.2 Page 30 2. 3. OP7 OP7 4. 5. OP27 OP32 Holmlea Care Home 6. 7. 8. 9. OP16 OP32 OP36 OP27 10. OP27 improve the care provided. The complaints procedure displayed at the home should include the up-to-date address and telephone number of CSCI to ensure that people can contact us if they wish to. Regular staff meetings should take place to improve communication between the management and staff team. Regular 1 to 1 supervision should take place to ensure that staff and managers have the opportunity to raise issues in a formal way. Dependency levels of individuals living at the home should be regularly assessed and reviewed and the information used to ensure that there is the correct level of staff to meet peoples needs. Where deputy managers working hours have been included as direct care hours, these times should be used undertaking care tasks to ensure that adequate time is provided for meeting people’s needs. Holmlea Care Home DS0000035767.V363317.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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