CARE HOMES FOR OLDER PEOPLE
Holmpark 212 Hagley Road Edgbaston Birmingham West Midlands B16 9PH Lead Inspector
Amanda Lyndon Unannounced Inspection 18th July 2006 07:30 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 Holmpark DS0000016908.V304376.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. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Holmpark Address 212 Hagley Road Edgbaston Birmingham West Midlands B16 9PH 0121 456 3738 0121 454 4495 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) Anchor Trust Mrs Pearl Moore Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (39), of places Physical disability over 65 years of age (39) Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to accommodate 39 adults over the age of 65 who are in need of care for reasons of old age, not falling within any other category (39), Physical Disability over 65 years of age (39), Dementia (39). Flat 39 is to be used only for the purpose of respite care. Minimum staffing levels must be maintained to at least 4 care staff at all times during the waking day. This must be increased at peak times to meet the needs of the service users. Care manager hours, ancillary staff and activities co-ordinator should be provided in addition to care staff. 19th January 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Holmpark is situated on a main road close to Birmingham City Centre and is within easy reach of public transport facilities and other amenities. The Home is a listed building, which had an extension built in 1988 and is well maintained both internally and externally. There is a large mature well-maintained garden to the rear with adequate parking to the front of the property. Holmpark provides residential accommodation to 39 residents for reason of old age and dementia. Accommodation is provided over three floors, which are accessible via two passenger lifts, in 37 single flats and 1 double flat. Each flat is provided with a small kitchen area, equipped with a small fridge and en-suite facilities that consists of a toilet and hand wash basin. There is an en-suite shower in the two ground floor flats, one of which is only used for respite care. Telephone and television points are available in each room. There is a range of assisted bathing facilities throughout the Home and other aids to assist residents with impaired mobility and wheelchair users. There is a laundry service and the flats are cleaned weekly. There are large notice boards in the reception area of the Home displaying any forthcoming events and other information of importance for residents and visitors. The weekly fee to live at the Home is from £368 to a maximum of £420. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report reflects the findings of a one day unannounced field work visit undertaken by one Inspector when there were thirty six residents living at the Home. Information was gathered by speaking with residents and staff, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. Residents met during the visit expressed their satisfaction about the services provided at Holmpark. What the service does well:
Regular care reviews are held at the Home in order to determine whether residents’ changing care needs are still being met living at Holmpark. Health care provision is good and staff support residents to access a range of Health and Social Care Professionals. Individual residents are allocated a “key worker” who is their main carer and responsible for ensuring that their care and daily living needs are attended to satisfactorily. One resident said “ I know who my key worker is, she helps me come down for breakfast every day”. Residents are cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. There were friendly interactions observed between residents and staff promoted a relaxed and homely atmosphere at Holmpark. A number of residents chose to hold the key to their flats and these can be overridden by staff in the event of an emergency. One resident said “ I choose to lock my flat and the staff can let themselves in if there is an emergency”. Residents are able to make phone calls in private using the public pay phone. There is a wide range of activities on offer at the Home for residents to participate in should they choose and this ensures that they are socially stimulated and free to enjoy the activities that they are interested in. One resident said “I had my own knitting stall at the fete last weekend and it was really successful”.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 6 Another resident said “ I have made some very good friends here, especially my next door neighbour who I sit by and talk with”. Residents are supported to continue to practice their chosen religions whilst living at Holmpark and this ensures that their beliefs and individuality are respected. Residents are supported by the staff to maintain contacts with their friends and family and visitors are made to feel welcome at the Home. This ensures that residents feel comfortable within their home environment. One resident said “ I enjoy going to my daughters for lunch on a Sunday and I’m going to stay at my son’s house for a few days soon”. Residents are given choice and freedom to make decisions regarding their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home. Residents are encouraged to personalise their bedrooms to reflect their individual tastes and interests. One resident said “ I have got my own carpet cleaner as I like to do some of my own housework. I help out with laying the dining tables which I enjoy doing”. Another resident said “ I like to use my own soap, talc and make-up, it makes me feel nice”. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. There are opportunities for residents to taste new foods which many residents enjoy. One resident said “I was underweight when I came to live here, but look at me now, I’m a healthy weight. If we suggest any new foods to eat, the Home always get it for us”. Residents live in a clean, homely and well maintained environment and this ensures that their comfort is maintained. One resident said “ I have always felt at home here, from day one”. Appropriate equipment and aids are available for residents with physical disabilities in order to promote their independence and to prevent both residents and staff from physical injury. There are hand rails appropriately located throughout the Home. Comprehensive staff training is provided and this ensures that staff acquire the appropriate knowledge to provide a good standard of care for residents. Residents are invited to regular group meetings to discuss the services provided at the Home and service satisfaction questionnaires are distributed regularly. This enables individuals to put forward their suggestions for any improvements and there was evidence that these were acted upon. There is a robust system for the safekeeping of residents’ personal allowances if they choose to use this service.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
On admission to the Home comprehensive assessments of residents’ individual care needs are undertaken including mental health care needs, however care plans are not always derived from this information and this may prevent residents from receiving individualised care.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 8 Poor practice in respect of the recording on medication administration charts may put residents at risk. Staff training in respect of the protection of vulnerable adults is required in order to safeguard residents. Remedial action is required in respect of the security of the physical environment and external grounds of the Home in order to make it a safe place for residents with dementia to live. Residents are not able to manually adjust the temperature of the radiator in their flats and this does not give them the freedom to control the temperature within their flats to suit their preferences. Residents are unsupervised in the lounge for periods of time and this may put individual vulnerable residents at risk. A review of staffing levels and the allocation of staff on duty must be undertaken to ensure that residents deemed to be at risk are closely supervised. However, residents praised the attitude and helpfulness of all staff working at the Home. One resident said “If I need the staff, they always come and help me”. The staff recruitment procedure is robust however a lapse in procedures on occasions does not safeguard residents. 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. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment and admission processes are comprehensive and enable prospective residents to make informed decisions about whether they would like to live at Holmpark. Care provided to residents is reviewed regularly to ensure that their individual care needs could still be met at the Home. EVIDENCE: The statement of purpose had been reviewed since the last field work visit and this contained all information required by Regulations. A most comprehensive and informative service user guide had been produced and copies of these were available in each residents’ flat to ensure that residents were aware of all of the services provided at the Home. This was available in a large print format for residents with poor eye sight. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 11 On admission to the Home, residents receive an informative contract of terms and conditions of residency and these were signed as agreed by either the resident and/or their representative. Prospective residents are invited to spend a day at the Home and a comprehensive pre admission assessment of their individual care needs is undertaken at this time. This enables prospective residents to make a decision regarding whether they would like to live at the Home and know that their care needs could be met there. Regular care reviews are held at the Home in order to determine whether residents’ changing care needs were still being met there. Intermediate care is not provided at the Home. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. Health care provision and general care delivery is good, however the absence of care plans in some areas may prevent residents from receiving individualised care. Poor practice in respect of the recording on medication administration charts may put residents at risk. Residents are cared for in a respectful manner and ensuring that their dignity and self esteem are maintained. EVIDENCE: Since the last inspection positive work has been undertaken in respect of the care planning system used at the Home and this requires further development to include specific detail of the support required by staff to meet the care needs of individual residents. On admission to the Home comprehensive assessments of residents’ individual care needs, including mental health care needs are undertaken, however care plans were not always derived from this information. There were inconsistencies in respect of the detail included within the care plans about the
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 13 specific support required by staff to meet the individual care needs of residents. “Pen sketches” incorporated the physical, psychological and mental health care needs of residents and included good detail of individual residents’ preferences, tastes, interests and cultural and religious beliefs as part of the assessment process. A number of “life histories” were recorded in very good detail. Daily reports were recorded in good detail and described any activities that individual residents had participated in during that day. Since the last visit, nutritional risk assessments had been undertaken to ensure that any residents deemed to be at risk of malnutrition were identified. Fluid and food intake documents were maintained for those residents deemed to be at risk of dehydration or malnutrition due to a poor appetite. Health care provision was good and residents have access to a range of Health and Social Care Professionals who visit the Home regularly, including General Practitioners, Opticians, Social Workers, Dentists and Dieticians. The Home’s staff have developed a good rapport with the district nursing team who visit the Home twice a day to administer insulin to a resident who has diabetes. An effective key worker system is in place at the Home. One resident said “ I know who my key worker is, she helps me come down for breakfast every day”. The general management of medication at the Home was good, including the management of controlled drugs. Audits of liquid, boxed and eye drop medications are undertaken regularly to ensure that the medication is being administered as prescribed and identify any areas of concern. There were robust systems in place for the receipt, storage and disposal of medication and all senior staff responsible for the administration of medication had recently undergone practical reassessments to determine their competency in this area. However not all staff were working to an acceptable standard in this area. Medication had been signed on a medication administration chart (MAR) as having been administered to a resident, however during the field work visit it was found that the medication had not been administered as the tablets were still in the blister packs. This may pose a risk to the health of the resident and an immediate requirement was made in respect of this. The actual number of tablets administered in respect of variable dosages was not always recorded on the MAR charts. This prevents accurate auditing of this drug to be undertaken and prevents the monitoring of the effectiveness of the treatment prescribed. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 14 Prescription creams were not being signed for following administration. One MAR chart stated that the resident was self administering their own creams, however this was not the case and the care staff were responsible for this. Prescription creams must be signed for following administration as confirmation that the residents have received the correct treatment. The label on one prescription cream stated “ apply as directed” and did not state the frequency or site of application and this may prevent the resident from receiving the correct treatment. The Deputy Manager stated that she had discussed this with the resident’s General Practitioner in order to safeguard residents. A medication had been discontinued however this was not clearly identified on the MAR chart and this may be administered by mistake which would be a risk to the health of the resident. Residents are cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. There were friendly interactions observed between residents and staff. A number of residents chose to hold the key to their flat and this promotes their independence and privacy. One resident said “ I choose to lock my flat and the staff can let themselves in if there is an emergency”. A pay phone was available for residents to use and this was located in a private and quiet area of the Home. The preferred name was recorded within individual residents’ care plans for reasons of choice or cultural expectations and staff were observed to be greeting residents using these. The preferred spoken language of individual residents was recorded within the initial assessments and included information about any barriers to communication due to reasons of health or culture. The support required by staff and other relevant sources to overcome any such barriers were identified and it was evident that this action was being implemented. For example, the family of one resident were supplying the staff with a phrase book and body language was also used effectively. Assessments also identified individual residents’ preferences, if any, for male or female carers to attend to their personal care needs and this ensures that individual residents feel secure and relaxed whilst being supported in this area. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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 activities on offer meet the expectations, interests and abilities of residents. Resident are supported to maintain contacts with their families and friends. Residents are given the choice and freedom to make decisions about their daily lives and this ensures their independence and individuality are maintained. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: There was a wide range of activities on offer at the Home for residents to participate in should they choose and this ensures that they are socially stimulated and free to enjoy the activities that they are interested in. There are two part time activity organisers employed at the Home and they arrange activities including reminiscence, dancing nights, handi- crafts, fish and chip suppers with entertainment, quizzes, exercise to music and cheese and wine tasting. The hairdresser visits the Home each week.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 16 One resident said “ I really enjoyed the summer fete last weekend”. Another resident said “I had my own knitting stall at the fete last weekend and it was really successful”. There were opportunities for residents of the Roman Catholic faith to practice their chosen religion, however the uptake of the weekly church service had been poor and as a result of this the local Christian church no longer visits the Home. The staff are aware of how to provide opportunities for worship for residents of non Christian faiths, and have done so in the past, however this is not currently required. One resident said “ I have made some very good friends here, especially my next door neighbour who I sit by and talk with”. There is an open visiting policy and residents are free to entertain their guests in whatever part of the Home that they choose. This ensures that residents feel confident and supported when they have visitors. Residents are able to go out side of their own with their friends and families as they choose. One resident said “ I enjoy going to my daughters for lunch on a Sunday and I’m going to stay at my son’s house for a few days soon”. Residents are given choice and freedom to make decisions regarding their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home. One resident said “ I have got my own carpet cleaner as I like to do some of my own housework. I help out with laying the dining tables which I enjoy doing”. Another resident said “ I like to use my own soap, talc and make-up, it makes me feel nice”. The menus on display identified a wide variety of nutritious and home made meals, using fresh ingredients, incorporating a number of different cooking styles and dishes to suit the tastes of all residents living at the Home. In addition to the two main meal options at lunchtime, other alternatives were also available daily on request. A hot meal option was available at tea time and a snack meal was provided in the evening and during the night as requested. Residents are involved in the planning of new menus at the Home and regular “food tasting from around the world” sessions are arranged by the Chef Manager which many residents enjoy. Menus are changed regularly and were suitable for the time of year. Meals are provided for residents with special dietary requirements due to reasons of health or cultural preferences and ingredients are bought in especially and cooked for these individual residents. Caribbean and Chinese food is currently available at the Home in addition to traditional English food.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 17 One resident said “I was underweight when I came to live here, but look at me now, I’m a healthy weight. If we suggest any new foods to eat, the Home always get it for us”. The breakfast served was of a continental style and there was a wide choice of cereals which the residents were very happy with. A cooked breakfast is available at the weekend. Staff were serving and assisting residents in a respectful manner, the dining tables were laid attractively and there were good social interactions between residents at the dining tables. The Deputy Chef was asking each resident what they would like to choose from the menu options for the following day. One resident said “You can’t fault the meals here at all and there is always a choice”. An “Orient Express” themed meal for residents and visitors arranged by the Chef Manager, involving all of the staff team had been a huge success. It was pleasing that staff were respectfully encouraging residents to drink extra fluids on the day of the fieldwork visit due to the extraordinarily hot weather and milk shakes made from ice cream were being served to keep residents cool. The period of time between when breakfast and lunch was served was three and a half hours and it is recommended that a review of this be undertaken in order to space out the meals evenly throughout the day. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 18 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The comprehensive complaints procedure is accessible to residents and their visitors should they need to make a complaint. Complaints are investigated in a timely and appropriate manner. Failure to follow correct adult protection procedures puts residents at risk. EVIDENCE: The complaints procedure had been amended since the last inspection and this included all relevant information and was on display in a prominent position in the Home. “Compliments, Concerns and Complaints” questionnaires are available in the reception area of the Home for residents and visitors to complete if required and there was a suggestions box provided. CSCI had not received any concerns, complaints or allegations about this service since the last field work visit. The complaints log held at the Home identified four complaints that had been investigated by the management team since the last field work visit. The written records in respect of the complaint investigations were good identifying any action taken and outcomes. In addition to the above but not recorded in the complaints log, the management team investigated a complaint made by a resident living at the
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 19 Home about the noise from staff lockers that could be heard from their flat. This was investigated and remedial action was undertaken in a timely manner to the satisfaction of the complainant. An incident of an adult protection nature had occurred at the Home during the month prior to the fieldwork visit. However the correct adult protection procedure had not been followed, the relevant people had not been informed regarding this putting residents living at the Home at risk. Despite training being provided in this area, staff knowledge regarding adult protection issues appeared to be poor and local multi agency guidelines were not incorporated within the adult protection policy. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and clean environment. However the safety of a number of residents with dementia care needs is compromised by the current security measures in respect of the physical environment of the Home. There were appropriate aids and adaptations available for residents’ use and this ensures that their comfort and independence are maintained. The manual cleaning of commode pots may pose a risk to the health of residents and staff. EVIDENCE: A number of residents living at Holmpark have dementia care needs and exhibit challenging behaviour. Individual residents deemed to be at risk if out side of the Home on their own had managed to do so without the knowledge of the staff on duty and this is of particular concern due to the Home being located on an extremely busy main road. Urgent action must be made to ensure that all residents are safe and secure whilst living at Holmpark.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 21 Residents deemed to be at risk had left the building via the front door when visitors are let in by the staff using the intercom system instead of opening the door in person and via the garden which has two gates onto the front drive way and unrestricted access to the main road. Risk assessments had been written in respect of individual residents going out side of the Home on their own who are deemed to be at risk, however such incidents continued to occur. The main reception desk located by the front door is in a good position to monitor people in and out of the Home, however this is often left unattended as the care staff responsible for covering this area are often needed to work elsewhere in the Home. The management and administration office is located on the first floor of the Home, away from the reception area of the Home. The garden was well maintained and attractive although not secure. A number of residents were using this facility on the day of the field work visit and enjoying the hot weather from the shade of the garden furniture. The pond at the bottom of the garden had been drained, was fenced off and was due to be landscaped in order to safeguard residents. Following the field work visit, CSCI were informed that the garden had been made secure for residents to enjoy. The main lounge was decorated and furnished to a high standard and was split into two areas. There was smaller seating areas positioned in quiet areas throughout the Home and the Management team were considering a conservatory type facility for residents to enjoy. The dining room was decorated in an elegant and homely style and was welcoming for residents who chose to have their meals in there. There were suitable assisted bathing and showering facilities at the Home, in an adequate number to meet the needs of residents living at the Home and these were clean and inviting. Since the last inspection the call bells within these areas had been repositioned to ensure that they could be accessible to residents from all areas of the room. Appropriate hoisting and pressure relieving equipment was available for residents with impaired mobility to safeguard the health of both residents and staff. Hand rails were provided in corridors and emergency call bells were available in all residents’ flats. Residents’ flats were decorated to a high standard and had been personalised to reflect their individual tastes and interests. Bed linen and other furnishings were of a good standard and had been chosen by the residents. New carpets had been fitted in a number of flats and a lockable storage was provided in each flat for residents’ use.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 22 One resident said “ I have always felt at home here, from day one”. Residents were not able to manually adjust the temperature of the radiator in their flat and this does not give them the freedom to control the temperature within their flat to suit their preferences. Hot water delivery temperature checks are undertaken regularly and it was noted that the temperature of the water in one of the flats and en suite just exceeded safe limits. Remedial action was undertaken to rectify this in order to safeguard residents. The Home was clean and fresh on the day of the field work visit and there was a hygienic and effective system for the laundry of residents’ personal clothing and bed linen in place. There were currently five residents using commodes during night time hours and appropriate mechanical commode pot washer/disinfector facilities were not available at the Home for the hygienic cleaning of these which may place the health of both residents and staff at risk. Based on the increasing dependency levels of residents coming to live at the Home, professional advice must be sought in respect of the need of providing appropriate sluicing facilities for staffs’ use. Following the field work visit independent professional advice was sought about the need for an appropriate mechanical commode pot washer/disinfector and plans are now in place for this to be included within the Home’s budget for next year. An interim infection control risk assessment was undertaken and a care procedure was written for staff to refer to when manually cleaning commode pots in order to eliminate the risk of cross infection. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a stable permanent staff workforce and this ensures that residents receive continuity of care. Residents’ safety may be compromised by inadequate supervision during peak times. Staff recruitment procedures are generally robust, however a lapse in procedures on occasion may put residents at risk. Staff training ensures that staff acquire the appropriate knowledge to support residents in a competent manner. EVIDENCE: Residents praised the attitude and helpfulness of all staff working at the Home. One resident said “If I need the staff, they always come and help me”. There are currently no staff vacancies, agency staff are not used at the Home and the staffing rotas identified that the Home were working within previously approved staffing levels, however this required review based on the increased dependencies and dementia care needs of residents living at the Home. Residents in the main lounge were left unsupervised for periods of time during the fieldwork visit and this places individual residents at risk. One resident had attempted to stand unaided and this was brought to the attention of the Deputy Manager who attended to the resident without delay. Staff stated that the reason for this was due to the fact that the care staff were responsible for covering the main reception desk and as a consequence of this there were not enough staff on duty to be allocated in all areas of the Home.
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 24 The staffing rotas identified that the skill mix of staff and ancillary support was depleted during weekend hours and this should be reviewed to ensure that a constant good standard of care is provided at the Home. The Registered Manager and Deputy Manager provide on call support to the person in charge of the shift during unsocial and weekend hours. Staff recruitment files included most of the information required by Regulations and were well organised. An appropriate reference had not been sought regarding one staff member sampled and this may put residents at risk. Satisfactory POVA checks had been obtained for all staff working at the Home and with the exception of two staff members satisfactory criminal records clearance had been obtained. The Registered Manager stated that she would contact the Criminal Records Bureau (CRB) to determine why there has been a delay in the return of the CRB checks outstanding. 46 of care staff had been awarded the NVQ level 2 in Care qualification and a number of care staff are currently working towards this. Staff had received other training relevant to their job roles including infection control, dementia care, communication, dining with dignity, care planning, end of life, medication and skin care. Staff were responsible for maintaining their individual staff training portfolios and new staff undertake a comprehensive induction in order to obtain the appropriate knowledge to work competently and provide a good standard of care to residents. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This is well managed Home and systems for resident consultation are good ensuring that they are able to put their views forward about the services provided at the Home. There is a robust system in place for the safekeeping of residents’ personal allowances should they choose to use this facility. Staff are trained in health and safety issues in order to safeguard residents. Equipment used a the Home is checked for safety. EVIDENCE: The Registered Manager had been in post for a number of years and has recently been successful in completing the Registered Managers Award. Positive comments were received from the residents and staff about her management style during the field work visit. The Deputy Manager provided support to the Registered Manager, a Chef Manager and part time
Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 26 Administrator were also employed and it was apparent that there were good working relationships and communications within this team. Residents are invited to regular group meetings to discuss the service provided at the Home and this enables individuals to put forward their suggestions for improvements. One resident said “ I attend the residents meetings. We have them every month. The Manager, Pearl attends the meetings and anything that we ask for is acted on”. Staff meetings are also held regularly in order to monitor and improve the standard of care provided. Quality monitoring visits are undertaken regularly by External Managers and reports of the findings of these were available. Service satisfaction questionnaires had been distributed and a report based on the findings of these had been published and were available for all residents to access. This included comments from residents and visitors who used the service and were used to monitor and improve the standard of care provided at the Home. As previously agreed with CSCI, residents’ personal allowances are paid into one general bank account and individual electronic and paper records of this were well maintained safeguarding residents who choose to use this facility. Staff had received training in health and safety issues including fire safety, food hygiene, first aid, moving and handling and health and safety and ongoing refresher training was provided in these areas. A fire drill had been undertaken recently and this ensures that staff had the appropriate knowledge to provide a good standard of care to residents. Maintenance and safety checks in respect of equipment used at the Home were undertaken regularly and this safeguards residents. Accident records were well maintained and included good detail of any action taken following an accident and the outcome of this. A bottle of liquid hand sanitizer had been left in one of the communal bathrooms and this would be harmful to residents’ health if accidentally ingested and must be stored securely at all times. Holmpark DS0000016908.V304376.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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 2 3 3 3 x 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 2 Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 28 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(1) Requirement The care planning system must be further developed to include detail of the specific support required by care staff to meet individual residents’ care needs Timescale for action 18/10/06 2. OP9 13(2) Any reasons for omitting 18/07/06 medication must be recorded on the medication administration chart (MAR) and medication that is omitted must not be signed for as administered on the MAR chart. The Registered Manager received this in the form of an immediate requirement 18/07/06 The actual dosage administered in respect of variable doses must be recorded on the MAR chart Prescription creams must be signed for as confirmation of application Any medication no longer prescribed must be clearly identified as discontinued if still listed on the current Mar chart. 3. OP9 13(2) Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 29 4. OP18 13(6) 37 The correct adult protection procedure must be followed using local multi agency guidelines for all incidents of a suspected or actual abuse 19/07/06 5. OP18 13(6) 18(1)(c)(i ) 6. OP19 13(4) 7. OP27 18(1)(a) The Registered Manager received this in the form of an immediate requirement The adult protection 31/08/06 policy/procedure must be further developed to include local multi agency guidelines and staff must receive further training in respect of this. An urgent review and remedial 31/08/06 action must be undertaken in respect of the security of the building in relation to accommodating both existing and future residents with dementia care needs. Consideration must be given to the monitoring of persons in and out of the building and how this can best be achieved, including care staff allocation, the responsibility of covering the reception desk, the siting of the Managerial/Administration office and the use of the intercom system in order for visitors to gain access to the building instead of the front door being opened in person by a staff member. Staffing levels and staff 15/08/06 allocation must be reviewed based on the dependencies and complex mental health needs of some of the current residents living at the Home. Vulnerable residents must not be left unsupervised in the lounge. 50 of care staff must have achieved NVQ level 2. New staff must not commence
DS0000016908.V304376.R01.S.doc 8. 9.
Holmpark OP28 OP29 18(1)(c )(i) 19(1) 30/11/06 18/07/06
Page 30 Version 5.2 employment at the Home without two satisfactory appropriate references. Any gaps in information on prospective staff members’ application forms must be explored COSHH products must be stored securely at all times. The Registered Manager received this in the form of an immediate requirement 10. OP38 13(4) 18/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP15 OP20 OP27 Good Practice Recommendations The times that meals are served should be reviewed in order for them to be more evenly spaced out over the day. It is recommended that consideration be given to the provision of another sitting area. It is recommended that a review of the skill mix of staff and ancillary support at weekends be undertaken. Holmpark DS0000016908.V304376.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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