CARE HOMES FOR OLDER PEOPLE
Holmwood 39 Chine Walk West Parley Ferndown Dorset BH22 8PR Lead Inspector
Tracey Cockburn Key Unannounced Inspection 21st December 2006 9:15 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 DS0000026820.V325103.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. DS0000026820.V325103.R01.S.doc Version 5.2 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 DS0000026820.V325103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2 double rooms Date of last inspection 27th July 2006 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 resident, although full time care is provided. The back garden has established shrubs, hedges and trees providing a sheltered environment. There is garden seating on the patio. The front garden has mature trees and shrubs; 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. The fees per week are: £410 - £475 For interested consumers the web link to the Office of Fair Trading which is concerned with value for money and fair terms of contracts is: www.oft.gov.uk DS0000026820.V325103.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection took place on a Thursday morning. The inspection was unannounced and started at 9:15 am. The purpose of the inspection was to review progress in achieving the outstanding requirements and recommendations from the previous inspection in August 2006. a total of 3 hours 15 minutes were spend in the home. At the time of the inspection there were 9 people accommodated in the home. There were two care staff on duty. During the inspection 5 residents were spoken too as were both members of staff and the registered provider, Mrs Gallagher. Care files containing the personal information of residents, policies and guidance for care staff on how things should run in the home and a tour of the premises were also part of the inspection. No comment cards had been received since the last inspection. There were no complaints since the last inspection and no adult protection investigations. What the service does well:
Holmwood has a good service user guide, which explains the services the home provides. The information within the guide is, the residents say, accurate and gave them a good idea of what the home would be like if they went to live there. Residents in the home are able to make decisions about their own lives with the support and assistance of care staff when needed. One resident who manages their own medication demonstrated this. Residents say that nowhere can replace their own home, but one said that the home enabled them to continue doing the things they liked to do. The residents have family and friends visit and are able to see them in the privacy of their own rooms if they wish. The owner of the home encourages residents to have control over their own lives, such as continuing to attend day centres or being able to smoke if they have done so all their lives. The home has a clear statement in their service user guide about their smoking policy. The home has a very stable staff team who have worked in the home for a number of years and know the residents well. This means that the residents have their needs clearly known by a dedicated group of staff. Staff have received the training they need to be able to do the job well including training DS0000026820.V325103.R01.S.doc Version 5.2 Page 6 in how to use a hoist and how to recognise the signs of abuse. The owner of the home is encouraging care staff to undertake a care qualification. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000026820.V325103.R01.S.doc Version 5.2 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 DS0000026820.V325103.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed prior to moving into the home. This ensures that people know the home knows their needs and can meet them. EVIDENCE: The home provides respite care for people if they have a vacancy. The file of someone receiving respite was looked at and this demonstrated that the provider had received an assessment of the individual’s care needs before they were admitted to the home. Other residents were aware that someone was in the home on a short term basis. DS0000026820.V325103.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans of care detail the needs of resident’s health, personal and social care, which means that care staff know what care they have to provide. Health care needs are met by the involvement of health care professionals. This means that residents can be confidant care staff recognise when to involve other professionals in their care. The home has a clear policy on medicines, which protects residents. Residents on the whole feel they are treated with respect and their right to privacy upheld. DS0000026820.V325103.R01.S.doc Version 5.2 Page 10 EVIDENCE: 3 care plans were looked at. All 3 contained the information care staff would need to know such as, what assistance someone needed to get washed and dressed. Each care plan seen covered the health needs as well as personal care needs of each resident. All 3 care plans had the date of the monthly review and the signature of the registered provider. 1 care plan detailed the action to be taken between 8am and 9am when the resident preferred to get up. Many of the residents in the home need only a little support and are able to manage their own personal care. There was evidence in the files such as times dates and action taken by health care professionals who visit the home. At the time of the inspection a district nurse was visiting to see one of the residents. This visit took place in the privacy of the resident’s room. 1 resident self medicates and keeps all their medication in their own room; this is not always locked away in a drawer. The registered provider has sought advice form her local chemist and they have been to the home to audit the medicines. At the time of the inspection there were only 2 residents up, 1 because they were going to a day centre and another because they are an early riser. All of the residents spoken to said they were able to get up in the morning when they wanted. DS0000026820.V325103.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole peoples experiences in the home match their expectations. This means the information they were given reflects what happens in the home. The home encourages contact with family friends and the wider community, which means residents are able to lead the life they wish to. Residents are supported to make choices about their lives, which give them control over the things which matter to them. Wholesome food is freshly prepared and served in a nice dining area, where residents can socialise. EVIDENCE: Residents said that they are able to choose whether or not they participate in any activities the home puts on. Every 2 weeks there is an Extend exercise class, which care staff, most residents attend. Once a week there is bingo and other entertainers also come to the home, the attendance at this can vary.
DS0000026820.V325103.R01.S.doc Version 5.2 Page 12 Residents said that they appreciate the entertainment when it happens. There are also lots of puzzles and jigsaws in the home for residents. There is no television in the lounge. Each resident has a television in their own room, so they can watch the programmes of their choice. Several residents said they preferred having their own television in their room. The owner said that the residents told her they prefer this. 3 personal care files were looked at. All 3 contained information on the hobbies interests and personal routines of the individual. Written information is given to residents. Residents say that they are able to see visitors in their own rooms. There is information about local groups that may come to the home and residents say they know they can choose whether they participate or not. Care staff said that they are very aware of each individual residents wishes and preferences. Most of the care staff have worked in the home for a number of years. Each resident’s room is full of their own personal items and possessions. The home has a well-stocked freezer. On the day of the inspection there were fresh vegetables such as cauliflower and carrots in the store cupboard. The larder was stocked with tinned soups, salmon and dried goods. There was fresh milk and bread. One of the members of staff was cooking lunch; roast chicken and fresh vegetables. The member of staff discussed how it is difficult to introduce new meal ideas. She then sited the example, of the day, she prepared fish pie. She spoke to all the residents after the fish pie and only 2 people said they liked it. She said there was more food wasted at the end of that lunch than ever before. The owner Mrs Gallagher said she had spoken to all residents about the food and menu options and found out that very few people liked the turkey burgers so they have removed them from the menu. Mrs Gallagher has now drawn up a teatime menu, which contained a great deal of choice such as a variety of sandwiches, quiche, fish and pasta dishes. Mrs Gallagher was very clear that she will provide any food that residents want as she is keenly aware that food is an important part of residents lives. Mrs Gallagher says that she plans to do a quality assurance audit of the food provided in the home. One resident said that the food was very good. There are hot and cold drinks available at any time of the day or night. DS0000026820.V325103.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home and visiting should be confident that their complaints and concerns would be listened to and acted upon. Training has been provided for all staff, which means that residents should be protected from abuse. EVIDENCE: There have been no complaints made to either the home or the commission since the last inspection. The owner, Mrs Gallagher explained that all the care staff have received adult protection training 2 years ago. There have been adult protection investigations at Holmwood since the last inspection. The home has a policy on adult protection and care staff are aware of the policy and the action they need to take. Care staff said they were aware that Mrs Gallagher was organising further training for them. DS0000026820.V325103.R01.S.doc Version 5.2 Page 14 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 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in an environment, which has improved which means they are much safer both inside and outside the premises. The home is clean, pleasant and hygienic which means it is a nice place to live. EVIDENCE: Since the last inspection, the outside of the home has been tidied up and the ivy is no longer trailing across the path to the front door. The old oven was no longer sitting on the patio at the rear of the home. The paint pots had been removed from the steps of the fire exit. Inside the home the clutter in the small lounge has been completely removed and no longer presents a tripping hazard to residents. A number of chairs have also been taken out which means that there is space to walk about.
DS0000026820.V325103.R01.S.doc Version 5.2 Page 15 The old carpet has been replaced throughout the home. Several residents were asked about the new carpet and one said,” It’s a much better colour and looks much nicer than the old one”. The lounge and dining room have also been decorated. Trees surround the home and the leaves have not yet been cleared away on the patio. However, several residents said they would not walk out on the patio at this time of year, as it was too cold. The patio furniture was not tidied away. At the time of the inspection the company the registered provider uses to undertake all fire checks was visiting to leave the certificate. This work had been done the week before the inspection. The home was very clean at the time of the inspection and there were no offensive odours. The laundry room is a very small walk-in cupboard at the end of a long corridor. There are no hand washing facilities in this room. The laundry floor has an impermeable finish. The washing machine is able to wash dirty laundry at an appropriate high temperature. The laundry room was not locked at the time of the inspection. DS0000026820.V325103.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet the care needs of the residents. Care staff have the training they need which means that residents are in safe hands. The home has a recruitment policy and practice, which should protect residents. Care staff have the training to be competent in their jobs and ensure residents are well looked after. EVIDENCE: Care staff on duty demonstrated through action and in conversation that they knew the residents well and understood how they preferred to be care for. During the inspection both members of staff on duty said they were apprehensive about undertaking training however both members of staff also said that they were keen to learn and could see the relevance in the job they do. DS0000026820.V325103.R01.S.doc Version 5.2 Page 17 The website: www.skillsforcare.org.uk will give advice on training and funding and the registered provider will be able to download knowledge sets. There have been no new staff recruited since the last inspection. In previous inspections there have been no concerns about the homes recruitment practice. The registered provider explained that the care staff have received training and this is updated every few years. The chemist from Boots has been in the home and audited the medicines and provided training for staff. Mrs Gallagher is also aware of the training standards for induction and foundation learning for her staff. The staff team at Holmwood is very stable and many staff have worked in the home for over 5years. Mrs Gallagher has not recruited any new staff since the last inspection. DS0000026820.V325103.R01.S.doc Version 5.2 Page 18 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The person in charge has the ability to run and manage the home well. This is to the benefit of the residents who live there. The home has systems in place, which demonstrate it is run in the best interests of the residents. Resident’s financial interests are safeguarded by the home policies and procedures. The health, safety and welfare of both residents and staff are protected by the actions of the owner. DS0000026820.V325103.R01.S.doc Version 5.2 Page 19 EVIDENCE: Mrs Gallagher has owned the home for a number of years and has day-to-day control. There are clear lines of accountability when Mrs Gallagher is not in the home; one of the staff on duty takes responsibility for the shift. Mrs Gallagher has undertaken annual quality assurance questionnaires. A record is kept of the outcome and a short report is written. Each year Mrs Gallagher focuses on a different aspect of care in the home and tries to link this to the homes aims and objectives. Following the last inspection Mrs Gallagher did a short questionnaire on what everyone thought of the homes staff and the job they do. The results were overwhelmingly positive. Mrs Gallagher has made progress with all the outstanding requirements from previous inspections. There are no requirements at the end of this inspection. Mrs Gallagher does not handle any resident’s finances. Care staff receive training in the safe working practices such as food hygiene, infection control and fire safety. Window restrictors were due to be installed on the day of the inspection. Safety procedures were posted in the kitchen. DS0000026820.V325103.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 DS0000026820.V325103.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 Timescale for action 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 Refer to Standard OP26 OP28 Good Practice Recommendations The laundry room should be clearly marked and kept locked when not in use. The registered provider should ensure that a minimum of 50 of care staff should have their National Vocational Qualification (NVQ) level 2. DS0000026820.V325103.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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