CARE HOMES FOR OLDER PEOPLE
Holmwood 39 Chine Walk West Parley Ferndown Dorset BH22 8PR Lead Inspector
Tracey Cockburn Unannounced Inspection 09:00 11 March 2006
th 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 Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 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. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holmwood Address 39 Chine Walk West Parley Ferndown Dorset BH22 8PR 01202 593662 NO FAX 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 Margaret Anne Gallagher Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2 double rooms Date of last inspection 4th August 2005 Brief Description of the Service: Holmwood Care Home is owned and managed by Mrs Gallagher, it is registered to accommodate a maximum of 13 elderly residents in nine single and two double rooms. The home normally operates with all rooms occupied singly. Nine of the bedrooms, all with en-suite baths or showers, are situated on the ground floor; the remaining two rooms are located on the first floor. The communal lounges and dining room are on the ground floor. There is no passenger lift or stair lift so those service users accommodated on the first floor need to be mobile enough to manage the stairs. The home usually accommodates the more independent type of resident, although full time care is provided. The back garden has established shrubs, hedges and trees providing a sheltered environment. Garden seating is available. Residents do not use the front garden areas but have mature trees and shrubs, which surround the home; a gravelled car parking area is available for visitors and staff to use. The home is situated in a quiet road a short drive away from the centre of Ferndown, which has a good selection of shops and local amenities. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken over 2.5 hours on a weekend morning. The purpose of the inspection was to review the requirements and recommendations from the previous inspection and was the second inspection of the annual cycle. Care files were looked at, 7 residents were spoken to, as were the 2 members of care staff on duty. The registered provider arrived at the home part the way through the inspection. What the service does well: What has improved since the last inspection? What they could do better:
At the conclusion of this inspection there are 4 requirements and 10 recommendations. The home needs to be able to demonstrate that residents are protected from abuse and they can do this through ensuring that all care staff receive training, they must be able to provide evidence of this training. The owner of the home must be able to demonstrate that the recruitment policy and practice in the home protects and supports the residents. The home must have induction training in place, which meets the correct standards. The home must also demonstrate that care staff are undertaking National Vocational Training to at least level 2. The homes statement of purpose should be updated to accurately reflect the service the home provides and thus ensuring that prospective residents have the information they need to make an informed choice. Assessments should be signed and dated to reflect the involvement of residents in the process and ensure they understand that the home can meet their needs. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 6 Residents should be able to make decisions about their health care needs and records should be accurately maintained. The homes policy and procedure on medicines should protect residents. There should be an accurate record of resident’s hobbies and interests and activities should reflect this. Residents should know the menu for the forthcoming week. Stains on flooring should be removed or the flooring replaced. The laundry room should be properly secure. The home should have a system in place to ensure that resident’s views are recorded and acted upon to demonstrate that the home is run in their best interests. 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. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 7 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 Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 8 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, 3 People thinking of moving into the home should have the information they need to make an informed decision. People who move into the home have their needs assessed however there is insufficient detail to be able to give assurance that the home and meet their needs. EVIDENCE: The recommendation from the previous inspection has been carried forward to the next inspection. The registered provider explained that she is in the process of have the care records such as the assessment updated. The new system has a more comprehensive assessment format however there is less information than the old system as although the boxes are ticked, there is little or no further information. The assessments are not dated and changes are not clearly recorded. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 9 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): 8, 9 Resident’s healthcare needs are responded to appropriately. The home has a policy and procedure for dealing with medicines however training for staff could not be evidenced. EVIDENCE: 5 care files were looked at and all contained information on health appointments and the result of any GP or district Nurse visit. However it was not always clear in individual care plans that the staff would know if there was something that they had to do. A district nurse saw one resident and the outcome of the visit was the advice that their feet should be soaked every day. This information was only in the daily care record and not in the care plan so it was unclear if this activity was taking place. This recommendation was not looked at this inspection and has been carried forward to the next inspection. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 10 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, 15 Resident’s find their experience of living in the home on the whole matches their expectations however there is little evidence of the home recording resident’s interests and hobbies. The home provides a balanced diet for residents. EVIDENCE: During the inspection residents where asked about their interests and any activities which take place in the home. One resident said that there is a woman who comes every fortnight to take an exercise session. They also have bingo and quizzes. There is also someone who comes and sings. During inspection of the care files there was a lack of information relating to individual resident’s interests, hobbies and previous occupations which means that the care staff are not fully aware of each residents personal history. All residents spoken to say that the food was good. The care staff record in the diary what meals are prepared each day. There is no menu choice however several residents said that if they do not like what is being cooked for lunch they always are given another choice. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 11 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): 18 The home has a procedure in place relating to adult protection but there is no evidence of staff training therefore it is reasonable to say that residents are not fully protected. EVIDENCE: This standard was not fully inspected and the requirement has been repeated. One member of staff said that they had not received adult protection training. In discussion with the registered provider it was unclear who was providing the training. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 12 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, 26 Resident’s live in a home, which is in the process of being improved; this means there are areas of the home, which are overly cluttered with items. The home is clean EVIDENCE: Since the last inspection the kitchen has been upgraded. The old cooker is sitting out on the patio and the registered provider said it would be removed. There are stains on the carpet in the hall and other communal areas as well as in some resident’s bedrooms. The registered provider said that the carpets would be replaced throughout the home in the near future once the slow leak from the central heating system has been repaired. At the time of the inspection the home was clean, there was some clutter in part of the lounge area. The laundry has been moved to a large cupboard at the end of a corridor, it is not clearly marked as the laundry room and was not locked at the time of the inspection. Residents say they always have clean sheets and their clothes nicely laundered.
Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 13 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, 29 Staff on duty understand the needs of the resident’s. The home’s recruitment policy and practice need to be improved to ensure that resident’s are supported and protected. EVIDENCE: At the time of the inspection there were 2 members of staff on duty supporting 9 residents. Both members of staff had worked in the home for at least 3 years and understood the needs of the residents, during the inspection 7 residents were spoken to and the majority said that the care staff understood how to support them. Several residents said that the care staff were “ very caring” One resident said that the care staff always have time to talk. The requirement from the previous inspection has been carried forward as the registered provider was present for only a part of the inspection. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 14 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): 33, 38 The home does not have a quality assurance system therefore it is difficult to know whether or not the home is run in the best interests of the residents. The home needs to do more to ensure that the health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The recommendation from the previous inspection ahs been carried forward to the next inspection as the registered provider was not available to discuss any action taken. The registered provider also said that some of the requirements and recommendations had not been addressed which is why they are repeated. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 15 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X 3 2 Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 16 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. Standard Regulation Requirement The home must be able to demonstrate that all staff have been supplied with training concerning the protection of vulnerable adults. The previous timescale of 31/10/05 was not met The staff recruitment, employment and supervision procedures must be updated to reflect the POVA guidance issued by the Department of Health in July 2004. The previous timescale of 31/10/05 was not met. During future inspections the registered person must be able to evidence that new staff are supplied with induction training to NTO specifications. In the meantime an action plan must also be provided to the Commission to demonstrate how 50 of the staff team will become trained to NVQ level 2 or the equivalent. The previous timescale of 31/10/05 was not met. Timescale for action 1. OP18 18 31/05/06 2. OP29 18 & 19 31/05/06 3. OP38 18 31/05/06 Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 17 4. OP38 24 &25 The registered person must produce a business and financial plan for the home, which includes quality assurance information, and subject to annual review. The home must be able to demonstrate financial viability. The previous timescale of 31/10/05 was not met. 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP1 OP3 OP8 OP9 Good Practice Recommendations The registered person should supply a copy of the amended Statement of Purpose to the Commission. The information should include the required details. (Previous timescale of 1.5.05 partly met). Assessment should contain full information and the prospective resident should be involved in the process. An accident record book that complies with Data Protection should be obtained and used in the home. The MAR charts should be routinely signed when the service user has taken their medicine. (Previous timescale of 1.5.05 partly met). All staff, who administer medicines, should have accredited training on medicines, how they are used and how to recognise and deal with problems in use. (Although Mrs Gallagher said that training has been supplied there was no evidence available to support her statement, this is therefore repeated from the previous report). Resident’s interests and hobbies should be recorded and this should inform the leisure and recreational activities within the home. The registered provider should consider having a menu available which is either given or explained to residents. A solution should be found regarding the removal of the stains on the hall carpet, or the carpet replaced. (Previous recommendation repeated). 1. 2. 3. 4. 5. OP9 6. 7. 8. OP12 OP15 OP19 Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 18 9. OP26 10. OP33 An action regarding the development of a proper laundry should be supplied to the Commission. Or the registered person should ensure that suitable arrangements are made to prevent infection at the care home. The laundry floor finishes must be impermeable, these, and wall finishes must be readily cleanable. (Changed from a requirement timescale of 30.9.05 not met). The registered person should develop the quality assurance system to include: The views of family and friends and of stakeholders in the community (e.g. GPs, chiropodist, voluntary organisation staff). Annual findings should be included into the business plan. Holmwood DS0000026820.V278439.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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