Inspection on 26/04/07 for Holmpark

This inspection was carried out on 26th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Holmpark 18/07/06

Holmpark 19/01/06

Holmpark 10/05/05

Holmpark 02/11/04

Holmpark 24/05/04

Holmpark 14/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Holmpark 212 Hagley Road Edgbaston Birmingham West Midlands B16 9PH Lead Inspector Amanda Lyndon Key Unannounced Inspection 26th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holmpark DS0000016908.V335687.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.V335687.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 pearl.moore@anchor.org.uk jane.ashcroft@anchor.org.uk Anchor Trust Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs 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.V335687.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. 18th July 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Holmpark is registered to provide residential care for up to 39 older people for reasons of old age, dementia or physical disability. It 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 run as one unit. It is well maintained both internally and externally and has adequate off road parking to the front of the Home. There is a spacious secure garden however at the current time people using the service have to negotiate steps to access the lawned area of this. Accommodation is provided over three floors, which are accessible via two passenger lifts, in 37 single flats and 1 double flat. Each flat has a small kitchen area, equipped with a small fridge, telephone, television points and ensuite facilities that consist of a toilet and hand wash basin. There is an en-suite shower in the two ground floor flats, one of which is designated for respite care. There is a range of assisted bathing facilities throughout the Home and staff are available to provide assistance in these areas. Aids and adaptations are available in order to enhance the quality of the lives of people using the service that have physical disabilities. There is a laundry service and the flats are cleaned weekly. Smoking is permitted in individual flats following a risk assessment so that people using the service are safeguarded. There are large notice boards in the reception area of the Home displaying any forthcoming events and other information of interest to people using the service. There is a variety of activities for people to participate in should they choose. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 5 Copies of the most recent CSCI inspection report and newsletters were available on display at the Home for anyone interested to refer to. The weekly fee to live at the Home is between £374.50 and £441. Items not covered by the weekly fee include hairdressing and private chiropody, dental and optical care. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service and complaints received by CSCI since the last key visit at the Home. In addition, the Registered Manager had completed a pre inspection questionnaire, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit seven completed questionnaires were returned to CSCI from people using the service and their families and these included positive comments about the service provided at Holmpark including: “I feel that my mother is safe and loved. Residents integrate well with each other and are encouraged to maintain their independence. All staff treat the residents with dignity” “The food provided is of a good variety and they are always looking at ways to improve things for the residents” and “The staff treat everyone as individuals which is marvellous… it’s home from home for my mother” One negative comment was received from the relative of a person using the service: “I think the staff ratio needs to be looked at because of the changing needs of some residents who appear to have health wise become more dependent” A random visit was undertaken at Holmpark on 19 December 2006 in order to monitor the progress made since the previous key visit dated 18 July 2006. The outcome of this was positive and a number of requirements made during the last key visit had been addressed and work practices had been revised as a result of this to improve outcomes for people using the service. Additional requirements were made during the random visit regarding care planning and delivery and the management of medication. This information was also taken in to consideration when planning for this visit. The unannounced key field work visit referred to in this report was undertaken over one day by one Inspector when there were thirty six people using the service, including one person who was receiving respite care. Due to the size of the service the information included within this report relating to the field work visit reflects a “sample” of the service. Information was gathered by speaking with seven people that use the service, the management team and two staff members. Additional methods of obtaining information included case tracking people that use the service, examining care, medication, staffing and health and safety records and observing the staff perform their duties. A partial tour of the Home was undertaken. No immediate requirements were made on the day of the visit Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 7 What the service does well: Prior to coming to stay at the Home people are encouraged to make informed decisions about whether they would like to live there and people are encouraged to sample what life would be like to live at the Home. One person using the service met during the visit said “When I came to view here everyone made me feel welcome” Following assessment people know before coming to live at the Home that their care needs could be met whilst living there. There is access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out and this ensures that any health care needs of people using the service are met. Staff provide support in a respectful manner so that the self- esteem and dignity of people using the service are maintained. People using the service are able to exercise control over their daily lives and the activities that they choose or choose not to participate in and this promotes their independence and individuality. There are no rigid rules or routines. One person using the service met during the visit said “We can get out of bed at whatever time we want, no one bothers us but the staff check that we are all right” Another person said “I am going back to my flat this afternoon to watch my favourite programme on the television. I still enjoy living here”. People using the service are supported to continue to practice their chosen religions whilst living at Holmpark and this ensures that their beliefs and individuality are respected. Visitors are made to feel welcome and a good rapport had built up between people using the service, staff and their visitors. One person using the service met during the visit said “We can go out with our visitors when we want to” There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. One person using the service met during the visit said “The food is good, you can have alternatives to the meals on offer” Complaints are generally investigated in an appropriate and timely manner so that the majority of people are confident that their views are listened to. One person using the service met during the visit said “I would speak to the Team Leader if I wasn’t happy about anything” Holmpark provides people using the service with a clean and homely living environment in which they are safe and secure and their privacy is respected. People are encouraged to personalise their flats to reflect their individual tastes, age, gender and culture so that they feel comfortable in their Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 8 surroundings. One person using the service met during the visit said “The cleaners are very thorough” Aids and adaptations are provided so that the independence, choice and dignity of people using the service are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. The gender mix of the staff team reflected the people using the service so that any preferences regarding this could be respected. Staff training is provided so that staff know all that they need to know to work safely and effectively and provide a good standard of care for people using the service. People using the service and their families are encouraged to put forward their suggestions about the service provided at Holmpark at group meetings and by the use of service satisfaction questionnaires. People using the service have the option of using the Home’s facility for the safekeeping of small amounts of money. What has improved since the last inspection? What they could do better: Care plans require further development to identify the specific support required by staff and must be reviewed with the involvement of people using the service so that their preferred routines are maintained whilst living at the Home. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 9 Skin assessments must be undertaken for all people when coming to stay at the Home and at regular intervals as deemed to be necessary following assessment. Staff must have the appropriate knowledge in this area so that people using the service do not develop sore skin. All prescription items and medication administration charts must identify dosage and administration instructions so that people receive their medication as prescribed by their Doctor. Opportunities for people to go outside of the Home on organised trips are limited and further consideration should be given to this so that the interests of people using the service are maintained. Staffing levels and staff allocation must be reviewed based on the dependencies and complex mental health needs of a number of people using the service in order to ensure that the care needs of people using the service are being met and that their health, safety and welfare is maintained. One person met during the visit said “There seems to be a need for more carers, the Home is short staffed and the carers have to use their own time off to take people out” Another person said “ The lounge is not always supervised and sometimes there are no staff at the reception desk” New workers must not commence employment at the Home until two satisfactory references have been obtained and any gaps in information requested on application forms must be explored in order to safeguard people using the service. 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. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 10 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.V335687.R01.S.doc Version 5.2 Page 11 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, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission processes are generally thorough so that the majority of people are able to make informed decisions about whether they would like to live at the Home. People know before admission that their care needs could be met at the Home. EVIDENCE: Prior to coming to live at Holmpark people are encouraged to visit in order to sample what life would be like to live there. During this time a comprehensive pre admission assessment is undertaken by senior staff using a revised assessment document to ensure that their individual care needs could be met whilst living there. Assessments of the care needs of people unable to visit the Home could be arranged in their own homes or hospital. The assessment Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 12 included detail of their personal view about coming to stay at the Home and this will assist in the planning of their care. Following assessment letters are sent out to individuals and their families as confirmation that their care needs could be met at Holmpark and to confirm the number of the flat reserved for them. One person using the service met during the visit said “When I came to view here everyone made me feel welcome” People come to stay at Holmpark on a four week trial period so that they have the opportunity to settle in to life at the Home. A six month and annual care review is undertaken so that people have the opportunity to put forward their views about the care and support provided to them whilst living at the Home. Pre review questionnaires are distributed to people using the service so that their views could be used in the planning of the review. The care needs of existing people using the service are reassessed prior to return to the Home following hospital admissions in order to ensure that their care needs could still be met at Holmpark. Intermediate care is not provided at Holmpark Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision and care delivery are generally good however inconsistencies in the detail recorded in care plans and the evaluation of these may prevent the preferred routines of people using the service from being maintained and may prevent their care needs from being met. People using the service generally receive their medication safely however the absence of administration instructions on a number of occasions may result in administration errors and this does not safeguard the people using the service or the staff member administering the medication. People using the service are supported in a respectful manner by staff and this ensures that their dignity and self esteem are maintained. EVIDENCE: During the visit people using the service expressed their satisfaction about the ways in which their personal care needs were being met whilst living at the Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 14 Home. All persons met during the visit had been supported by staff to choose clothing, jewellery and make up appropriate for their age, gender, culture and the time of year. One person using the service met during the visit said “I have a bath or shower once a week, the staff help me and this is the best thing about living here. Having a bath more than once a week is not necessary” A revised care planning system had recently been implemented and staff made positive comments about this as this was based on the individual views of the people using the service. This is an individual written plan outlining the support required by staff in order to meet the individual care needs of people using the service. On admission to the Home a “baseline” assessment is completed in order to identify if there had been any changes to the care needs of the person coming to stay at the Home since the pre admission assessment was undertaken and this is considered to be good practice. The documentation for this includes a skin inspection and sore skin risk assessment however this was not always being completed and may result in the development of sore skin for those people deemed to be at risk. Further guidance should be given to the staff team about the importance of this and the methodology behind the assessment tools provided regarding this so that they know all that they need to know to work effectively and provide a good standard of care. There was however evidence that medical advice is sought promptly for people who are at risk of developing sore skin and none of the people currently using the service had sore skin. There were inconsistencies in respect of the amount of detail recorded in care plans to identify the specific support required by staff to meet the individual care needs of people using the service. The majority of care plans were comprehensive and identified the specific support required by staff however, other care plans required further development to include the interests, social care needs, physical abilities and emotional well-being of people using the service. Care plans are written with the involvement of people using the service and/or their representatives so that their preferred routines could be maintained whilst living at the Home. The preferred term of address of individuals using the service was recorded in their care plan and staff greeted people using the service by their preferred names. Care plans identify the preferred gender of the staff member assisting with personal care needs so that their dignity was maintained. “Daily reports” had been replaced by “alert sheets” in order to highlight any significant events involving people using the service. As a result of this the Organisation stated that care plans must be updated to reflect any changes in care needs, however this was not found to be the case in respect of the care plans sampled during the visit. Care plan evaluations sampled did not reflect the care that had been provided stating “no change to this plan of care”. Anticipated review dates must be recorded on care plans instead of “ongoing” time scales so that individual care needs are reviewed in a timely manner. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 15 Personal risk assessments had been undertaken so that people using the service could lead fulfilling and safe lives whilst maintaining their independence. This included the risk of falls and moving and handling, the management of finances and their personal safety outside of the Home so that they were safeguarded. People using the service had access to a range of Health and Social Care Professionals including district nurses, psychiatrists, dieticians and community psychiatric nurses. People have the option of retaining their own General Practitioner on admission to the Home (If the GP is in agreement) The system in place for the re ordering and checking of medications in to the Home had improved greatly since the random visit to the Home and this ensures that people using the service receive their medication at the prescribed times. Medication records are audited regularly and variable doses are recorded so that an accurate audit trail could be maintained. Senior staff had received training about the safe administration of medication so that they have the knowledge to administer medication in a safe manner. As during the previous visit at the Home a number of administration instructions printed on to the medication administration charts (MAR) stated “give as directed”. In addition a counter signature had not been obtained for a hand written entry on to a MAR chart and these may result in administration errors and does not safeguard people using the service or staff. People using the service are able to administer their own medication so that their independence is maintained and staff provide support to ensure compliance in this are this safeguard the individual. One person met during the visit said “I administer my own medication and the staff order it for me” People using the service confirmed that their personal post was delivered to them unopened and this ensures that their privacy is maintained. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities on offer meet the needs, interests and expectations of the majority of people using the service. People using the service exercise control over their daily lives and staff respect their personal preferences in respect of this so that their independence and individuality are maintained. People who use this service have a choice of healthy meals that meet any dietary requirements for reasons of health, taste, religion or culture. EVIDENCE: There are a variety of activities available for people to participate in at Holmpark should they choose including in house entertainers, quizzes, arts and crafts, music and movement, sing a longs, cream teas and food tasting. Forthcoming events were on display in the Home so that people using the service could choose whether they wished to participate or not. There was a library at the Home and this included large print books for people with visual impairments. Audio books, braille and books in other languages could be obtained on request, however there was no need for this at the current time. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 17 Opportunities for people using the service to go outside of the Home on organised trips was limited however people were able to go out with friends and family as they chose. One person using the service met during the visit said “We can go out with our visitors when we want to” A twice weekly “trolley shop” had recently been introduced so that people unable to go outside of the Home could choose their own personal items. The majority of people using the service had dementia care needs and as a consequence of this one person met during the visit expressed his concern that opportunities to interact socially with other people using the service were very limited. This was brought to the attention of the management team who advised that they would arrange a social care review for this person in order to enhance his quality of life. People using the service are able to exercise control over their daily lives and there were no rigid rules or routines at Holmpark and one person using the service met during the visit said “We can get out of bed at whatever time we want, no one bothers us but the staff check that we are all right” Another person said “I am going back to my flat this afternoon to watch my favourite programme on the television. I still enjoy living here”. There was an open visiting policy and people using the service had the opportunity to meet with their visitors in private if they preferred. Visitors are invited to have a meal at the Home so that people using the service are supported to maintain links with those people important to them. Opportunities for worship for people of all faiths could be arranged and a Church of England service is held at the Home each month. None of the people currently using the service were of a non Christian faith and English was the first language of all people living there. The menus identified a variety of wholesome meals and included a choice of traditional English and different dishes so that the tastes of all people using the service were catered for. There were two main meal options offered each day and alternatives to these were also available so that people using the service had a good choice of food. The Chef Manager was very enthusiastic and strived to ensure that all people received a nutritious diet and ensured that meal times were important social events to enjoy. Special diets could be arranged for reasons of health, cultural and taste preferences and religious beliefs. At present diabetic and high energy diets were being prepared. The portions of pureed diets were served separately in keeping with good practice so that people had a choice of whether they wished to eat each portion. Cooked breakfasts were available twice a week and snack meals were available at supper time and during the night so that people were not hungry. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 18 Adapted cutlery and plate guards were available in order to promote the dignity and independence of people with physical disabilities however staff said that there was no need for this at the current time. Menus were available for people to refer to. The lunch time menu on the day of the visit had been changed due to remedial work being undertaken on the water systems at the Home. People using the service were informed of this change and the reason for this and they expressed their about satisfaction this. The revised lunch time meal choices on the day of the visit were fish and chips or egg and chips and these were well presented. A starter of soup was served and a choice of sweets was offered. One person using the service met during the visit said “The food is good, you can have alternatives to the meals on offer” Another person said “ we can have hot drinks and biscuits before bed” Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to people using the service and their visitors and complaints are generally investigated in an appropriate and timely manner so that the majority of people using the service are confident that their views are listened to. Systems are generally in place to protect people from harm. EVIDENCE: Since the last key visit CSCI have received six concerns, complaints and allegations about the service provided at Holmpark and these had been referred to the organisation for investigation. The majority of these had been investigated in a timely manner and one of these is currently ongoing as the complaint has not been investigated by the Organisation to the satisfaction of the complainant. These included the lack of supervision of vulnerable people in the lounge area of the Home, dining chairs not being fit for purpose, an accident involving a person using the service and an alleged theft of jewellery. Work practices had been reviewed in response to the majority of these however people met during the visit stated that the lounge remained unattended on occasions and an independent assessment of the dining chairs was recommended so that the safety of people using the service was maintained. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 20 The complaints register identified that two complaints had been made directly to the Home since the last random visit undertaken by CSCI. These were pertaining to no hot water being available in a flat and an episode of physical aggression between two people using the service. Remedial action was taken in an appropriate and timely manner in respect of both complaints so that people using the service were confident their views were listened to. The complaints procedure was on display in a large print format in the reception area of the Home so that it was accessible to all people currently using the service and their visitors. Complaint leaflets were available at the Home for people to complete if they wished. One person using the service met during the visit said “I would speak to the Team Leader if I wasn’t happy about anything” Staff had undertaken recent training about the protection of vulnerable adults and there was evidence that the correct procedures were followed in respect of these in order to safeguard people using the service. The adult protection policy included local multi agency guidelines so that staff were familiar with the correct procedure to follow in the event of alleged or actual abuse thus protect people from harm. Following an alleged theft at the Home, valuables/furniture inventory records had been introduced and these were signed by people using the service, their representatives and staff so that the Home could monitor the amount of valuables kept at the Home and ensure that it was held safely. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 21 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, 22, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are provided with a homely, clean and comfortable environment in which they feel safe and secure and their privacy is maintained. Aids and adaptations provided are fit for purpose and the needs of people using the service however the dining chairs may not maintain the safety of all people using the service. EVIDENCE: The Home was generally well maintained both internally and externally and there was a rolling programme of redecoration and refurbishment in place so that the comfort of people using the service was maintained. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 22 Since the last key visit remedial action has been taken regarding the living environment in order to maintain the safety of the increasing number of people using the service with dementia care needs. This included a keypad lock that had been fitted to the dining room door in order to prevent vulnerable people accessing hot water, a lock fitted to the garden gate to prevent vulnerable people accessing the main road and an additional patio area had been created to cover the pond. A number of people were enjoying the garden on the day of the visit however a number of steps had to be negotiated in order to access the lawn. Plans were in place to provide a ramped access to the main garden thus make this easily accessible for all people including wheelchair users. Plans were also in place for a raised flower bed so that people interested in gardening had the opportunity to tend to this. There was a lounge facility and additional smaller seating areas were located throughout the Home so that people using the service had a choice of where to sit and meet with their families if they chose not to use their flats. There was a hearing loop system provided in the lounge for people with hearing impairments. There were three mechanical hoists and other equipment used to transfer people with physical disabilities in a safe manner. A call bell facility was provided in each flat so that people could summons assistance from staff as required and in addition to this one person had a pendant style call bell, worn around her neck so that she could seek help if she fell. One element of a complaint received by CSCI was regarding the suitability of the dining chairs as there were no arms on the chairs provided thus may be considered pose a health and safety risk for people using the service. As part of the complaint investigation the Organisation had deemed these to be fit of purpose however it is recommended that an independent assessment of these be undertaken in order to safeguard people using the service. People are encouraged to personalise their flats to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. A safe facility is provided in each flat for the safe keeping of valuable or personal items and people using the service have the choice of having the key for their flats. One person using the service met during the visit said “I choose to keep my flat locked” Holmpark was clean and fresh on the day of the visit and one person using the service met during the visit said “The cleaners are very thorough” Holmpark DS0000016908.V335687.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People using the service do not receive support from an adequate number of staff on occasions and this may prevent their personal and social care needs from being met and their health and safety from being maintained. People using the service receive support from appropriately trained and recruited staff however a lapse in recruitment procedure on one occasion does not uphold their safety. EVIDENCE: Prior and during the field work visit a number of concerns were raised by people using the service, relatives and staff about the current staffing levels, in particular during early morning and late afternoon hours. Comments were received that the current staffing levels were inadequate due to the increasing dependencies of people using the service and their associated dementia and physical care needs. A concern was raised that the start time of the early shift did not give adequate time for personal care to be afforded to all people that chose to be served their breakfast in the dining room and this should be reviewed. During the last visit to the Home the lounge was not always supervised, the reception desk not always manned and further concerns of the same were raised during this visit. One person met during the visit said “There Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 24 seems to be a need for more carers, the Home is short staffed and the carers have to use their own time off to take people out” Another person said “ The lounge is not always supervised and sometimes there are no staff at the reception desk” Following the visit the Organisation advised that extra care hours have been allocated to the Home and that the staff recruitment process in this area has commenced. Kitchen, laundry, housekeeping and maintenance staff provide ancillary support for the care staff and this ensures that people using the service are supported in all aspects of their lives at the Home. One person using the service met during the visit said “The staff are very good here, they are very friendly” Agency staff are rarely used as the staff team cover periods of annual leave and sickness and this ensures continuity of care. The gender mix of the staff team reflected the needs of the people using the service so that staff provided support in an understanding manner. Staff recruitment files sampled included most of the information required by Regulations. Health declarations and criminal record checks had been obtained in order to safeguard people using the service. One staff application form was poorly completed and there was no evidence that information omitted from this had been obtained during interview. One reference pertaining to a new staff member did not identify the capacity in which they knew the referee therefore the validity of this was in question. All new staff undertake comprehensive induction training and staff had undertaken recent training including dementia care, urinary catheter care, basic food hygiene, health and safety, fire safety, infection control, back care, first aid and activities so that they had the appropriate knowledge to work safely and effectively. A fire drill had been undertaken recently so that staff were able to respond appropriately in the event of an emergency thus safeguard people using the service. 51 of care staff had achieved NVQ level2 and a number of staff had achieved NVQ level 3 so that they had the necessary skills to provide a good standard of care. Holmpark DS0000016908.V335687.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place for consulting with people using the service are improving and people are generally confident that their views are acted upon. The arrangements for health and safety are adequate and this safeguards the majority of people using the service. EVIDENCE: The Registered Manager has the required competence, qualifications and experience and is available to meet with people using the service and their families at designated times outside of “office hours” so that people have the opportunity to discuss the care provided at the Home. She is supported by the Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 26 Deputy Manager who is responsible for the care management at the Home and there are clear lines of accountability within the management team for the benefit of the people using the service. Staff meetings are held regularly and the minutes of the most recent meeting were available. This is an opportunity for staff to be introduced to new policies and procedures, training opportunities and services and care provided for people using the service. A residents’ meeting had been held recently and the minutes of this was on display in a large print format for people to refer to. Group meetings provide people using the service with opportunities to put forward their views about the service provided and put any suggestions for improvements forward. External Senior Managers visit Holmpark regularly in order to monitor the quality of service provided at the Home. There was evidence that the views of people using the service are sought during these visits and action is taken to address any issues raised or suggestions put forward. The quality assurance system was being updated and this included service satisfaction questionnaires that had been distributed to the relatives of people using the service. Plans were in place for these to be distributed to all people using the service so that their views about the service provided at Holmpark could be sought. People using the service had the option of using the Home’s facility for the safekeeping of small amounts of money. Separate transaction records were maintained for each person and these identified all expenditure. Receipts were available for all items purchased out of personal money and this system for this was audited regularly so that the finances of people using the service was safeguarded. Accident records were well maintained and audited regularly so that any trends in accidents involving people using the service were identified and remedial action could be taken to reduce the risk of further incidences of the same. There was evidence that prompt medical advice is sought as required following accidents involving people using the service. Fire risk assessments had been reviewed recently and maintenance checks of fire equipment were undertaken regularly so that equipment is safe to use thus protect people using the service. Holmpark DS0000016908.V335687.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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 x 3 x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Holmpark DS0000016908.V335687.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 All people using the service must have an up to date detailed care plan and this must be reviewed regularly with their involvement so that they receive person centred support that meets their needs Timescale for action 01/07/07 2 OP8 14 3 OP9 13(2) (time scale of 28/12/06 not met) Skin assessments must be 15/06/07 undertaken for all people when coming to stay at the Home and at regular intervals as deemed to be necessary following assessment. Staff training in this area must be provided. 01/06/07 All prescription items and medication administration charts (MAR) must identify dosage and administration instructions so that people using the service receive their medication as prescribed. (timescale of 28/12/06 not met) Countersignatures must be obtained for all hand written Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 29 4 OP27 18(1)(a) entries on to MAR charts so that people using the service receive their medication as prescribed. Staffing levels and staff 15/06/07 allocation must be reviewed based on the dependencies and complex mental health needs of an increasing number of people using the service so that their care needs are met and their safety is maintained whilst living at the Home. Vulnerable people must be supervised in the lounge at all times so that their health and safety is protected. (timescale of 28/12/06 not met) 5 OP29 19(1) New workers must not commence employment at the Home until two satisfactory references have been obtained and any gaps in information requested on application forms must be explored in order to safeguard people using the service. 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 30 No. 1 2 Refer to Standard OP12 OP20 Good Practice Recommendations Further consideration should be given to increasing the opportunities for people using the service to participate in trips outside of the Home. An independent assessment of the suitability of the design of the dining chairs should be undertaken so that the health and safety of people using the service is maintained. Holmpark DS0000016908.V335687.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holmpark DS0000016908.V335687.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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