Inspection on 25/01/07 for Holmwood

This inspection was carried out on 25th January 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmwood 09/02/09

Holmwood 13/02/08

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Holmwood 11 Harvey Lane Norwich Norfolk NR7 0BW Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 25th January 2007 09:30 Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 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 DS0000067560.V328743.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 Adults 18-65. 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 DS0000067560.V328743.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Address 11 Harvey Lane Norwich Norfolk NR7 0BW 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) Baytree Community Care (London) Limited info@careholm.co.uk Mrs Emma Louise Cliffe Care Home 32 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (26), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (2) Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/09/05 Brief Description of the Service: Holmwood is a care home registered to accommodate a maximum of 32 persons, but is currently offering only 30 places as some rooms that were originally for double occupation are now being occupied singly. Of these places 26 are for persons who fall within the category of Mental Disorder, with 4 places offered to persons who have Learning Disabilities. The premises occupy a sloped site in a residential eastern area of Norwich. There is a small parade of shops, pubs and access to the riverbank all within walking distance. There is a bus service into Norwich that passes close by. The main house is a former period residence, with accommodation for 24 service users on 3 floors. A purpose built annex, known as the Lodge, was added some years ago and offers 6 en suite single rooms with an adjoining kitchenette, lounge and bathroom. There are two lounges in the main house along with a dining room. There is a small terrace with a seating area but the garden consists of mainly trees and shrubs. The main house is approached by a sloped driveway leading to a small car park to the side of it. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over five and a half hours. Opportunity was taken to tour the premises, look at care records and policies and communicate with the home’s service users and in addition with the staff and the management. The inspection report reflects evidence from the inspection of Key Standards. Only five comment cards were received by the Commission prior to the inspection. What the service does well: What has improved since the last inspection? Some rooms have been re decorated and the meals have improved. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 6 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. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users are appropriately assessed before admission. Staff collectively do not have the skills to care for this client group. EVIDENCE: Two case notes of newly admitted residents were examined, it confirmed that the process for assessing the resident before admission was suitable and allowed the home to ensure that they could meet the needs of the prospective residents. It is recommended that prospective service users or their representatives be sent a letter of confirmation stating that the home can meet their needs. It would appear that the staff do not individually or collectively have the skills to deliver the services, which the home claims to provide. (see Standard 32 related to training). Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service, the inspection process and discussion with management, staff and service users. Service users assessed need, changing needs and their personal goals are not reflected in their individual plan of care. The assessed needs are very vague and the prescribed care lacks detail. EVIDENCE: Six care plans were examined by the Inspector; it was evident that the assessment process was not linked to the formulation of planning care. The care plans lacked detail with no reference to therapeutic intervention in relation to their needs and diagnosis. The care plans showed no evidence of evaluation or service users or relative involvement. It was noted that some of the service users had problems that were identified in the daily notes but no care plans were in place to meet the changing needs of these individuals: this could lead to shortfalls in care and mistakes being made. The Inspector gained the impression from discussions with staff that there was not enough detail on the care plans and that the care plans were not used to give them guidelines for care. The care plans also lacked any reference to daily Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 10 activities and did not reflect cooking and household tasks that the service users are involved in; especially when it was supposedly part of their therapeutic intervention towards independence. Discussion with service users led the Inspector to believe that they did make decisions about their daily lives, however these decisions were not reflected in plans of care. Risk assessments were in place but not reflected in the overall plans of care for each individual or indicated service user involvement. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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 and discussion with service users and staff. Activities and meals are managed well. On the whole it would appear that the service users are encouraged to be in control of their own lives and enhancing their skills and developing their educational objectives although there is a lack of recorded evidence to substantiate this assumption. EVIDENCE: Those service users who are able are encouraged to participate in activities that reflect their abilities. A number of the service users attend mental health support groups and some of them also visit a farm and take part in agricultural activities that they apparently enjoy. One resident told the Inspector that he could not read or write when he went to the home some years ago and has been encouraged to go to sessions to enable him to do this which he has achieved and is now doing an IT course in basic skills. The home does not provide any in house activities because they feel that the service users should be enabled to participate in the community projects that are made available to them. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 12 It was noted however by the Inspector that none of these activities have been recorded on plans of care especially as many of the activities are therapeutic in nature and part of the service user’s intervention of care. A recommendation is made that all activities become part of the care planning process. The Inspector ascertained from the management and after discussion with some service users that their families do visit and some visit their families also. One resident had spent Christmas Day with their family. Discussion with the service users confirmed that they enjoyed their food and felt that it had improved greatly since the new providers had taken over; they also felt that they were given sufficient choices in relation to the manus. The menus looked well balanced and nutritious and it was noted by the Inspector that the service user’s weight was monitored on a regular basis. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and discussion with staff and management. The procedure for transporting medication around the home is not safe. It is not clear because of lack of recorded evidence that the service users are supported in the way that they prefer or that their physical and emotional needs are met. EVIDENCE: Those service users spoken to by the Inspector confirmed that they felt well supported by the staff however there is lack of detail in care plans to evidence this; for example those residents who obviously need guidance and support regarding personal hygiene do not have prescribed care related to this activity. General and psychiatric care is provided by visiting professionals, but once again, this activity is not reflected in any plans of care. The service users were able to share with the Inspector that they visited the GP when they wanted to and were supported to take up any other health care facilities that were required. No one self medicates in the home at the moment although the manager said that if able the residents were encouraged to do so. Examination of MAR charts showed some shortfalls in the documenting of medicines that had been administered or not administered; inaccurate records means that it is not Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 14 possible to know whether residents have received their medication as prescribed. It transpired during the checking of the procedure for transporting medication around the home for administration purposes that the home did not have a safe procedure in place; the medication was being taken round the home in a non lockable heavy box for administration purposes. This is an unsafe practice and a requirement is made to ensure that an appropriate and safe system is put into place. A recommendation is made that Temazepam be kept in a secure cupboard for controlled drugs and a register be kept for its administration. Discussion with management highlighted that at times Boots does not always supply medication when requested and this can lead to problems especially related to this client group; it is recommended that the manager discusses these problems with the main pharmacist at Boots. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the 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 and discussion with staff and service users. Arrangements for dealing with complaints are satisfactory. EVIDENCE: The Inspector examined the records for complaints. One complaint that had been received by the home was in relation to the state of one of the resident’s rooms. Records show that the home investigated the complaint; that it was substantiated and that it was dealt with in an appropriate manner. All residents on admission are given the complaints procedure and all those service users spoken with knew exactly how to make a complaint and felt that they could do this if the occasion arose. Staff spoken with, were very aware of issues relating to the protection of vulnerable adults but confirmed they had only watched a video for this purpose and it is recommended that they attend some form of formal accredited session for this. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and an extensive tour of the home and available evidence. The premises are not clean and there are no systems in place to control the spread of infection. Service users do not live in an entirely safe environment. EVIDENCE: During a tour of the home a number of concerns came to light. All communicable toilets and washbasins had bars of soap and one towel. This is not acceptable practice and the home is required to make suitable arrangements to prevent the spread of infection. The home generally was dusty and the resident’s rooms in some cases were unclean with dirty clothes lying around. Whilst the Inspector accepts the type of client group in the home can pose a problem with cleanliness, the home must provide support where needed to enable the residents to live in a safe infection free environment. It is understood that many of the service users have responsibility for keeping their own rooms clean and tidy, this was not evident from the care plans or that support to do this was in place. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 17 One first floor window did not have restrictors on it and considered to be unsafe and a requirement is made. One kitchen area had a pile of dirty linen on the working area which posses a problem for maintaining cleanliness and eliminating cross infection. It was noted by the Inspector that one toilet did not have any toilet paper. A lounge on the ground floor smelt strongly of urine. An electric socket in a residents room had plaster missing from around its casing. The rooms had evidence of personalisation and could be locked if desired by the residents. Overall the home is in need of refurbishment although it was evident that a few rooms had been re decorated. The designated laundry area does not have suitable walls that are easily cleaned and the washing machines are only domestic in use. All bed linen and towels looked grey in colour. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service and discussion with staff and management. Whilst the procedure for recruitment is robust much improvement is needed in relation to training and development of the staff. There are deficits within the current stafftraining programme. EVIDENCE: All records for newly appointed staff were examined and were seen to reflect a robust checking system before staff are employed. The staff records show that two references were obtained and also showed proof of identity. The home does not have a training and development plan and the manager is unsure of the training budget. Discussion with staff and management confirmed that not much training had taken place over the past years. The staff had certainly not attended any sessions on caring for persons with mental health problems and their knowledge and skills are limited in dealing with these people who have complex needs. Whilst it appears to the Inspector that the service users are not neglected, the staff would benefit from opportunities to increase their knowledge and skills as the knowledge they do possess has been gleaned over Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 19 the years they have been employed in the home and not on any formal footing. Not one member of the staff group hold a NVQ qualification, six members are undertaking NVQ2 at the present time. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service and information gained from service users, staff and examining records. There are management shortcomings that compromise the health, safety and welfare of service users and staff at the home EVIDENCE: The registered manager has managed the service for approximately six months and there are significant areas of non-compliance with National Minimum Standards referred to in this record. The registered manger has acknowledged that she has to make a number of improvements to ensure that the home meets the criteria of the National Minimum Standards. The home has some processes in place for monitoring the quality of the service it provides and this was seen by the Inspector and a recommendation is made so that the system is developed more so that the home can demonstrate how Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 21 various aspects of the service are improved. The non-compliance with National Minimum Standards at the home suggests that the quality monitoring system is not sufficiently effective. The health safety and welfare of service users are compromised by a number of the home’s practices, including medication practices, staff training including infection control and maintaining a safe environment. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 3 2 2 2 2 x Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (1) (2) (b) (c) Requirement Timescale for action 26/02/07 2 YA20 13 (2) 3 YA24 13 (4) (a) © 4 YA35 18 (a) (c) (i) The registered person shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met and keep the plan under review and revise the plan. The registered person shall make 25/01/07 arrangements for the recording, handling, safekeeping, safe administration of medication. The registered person shall 25/01/07 ensure that all parts of the home to which service users have access are reasonably practicable free from hazards and to their safety. The registered person shall 26/02/07 ensure that at all times suitably qualified competent and experienced persons are working at the care home and ensure that persons employed at the home receive training appropriate to the work they perform. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard YA2 YA14 YA20 YA20 YA23 YA24 YA30 YA39 Good Practice Recommendations It is recommended that letters are sent to prospective service users or significant others to confirm that their needs can be met. It is recommended that activities be recorded as part of the care planning system. It is recommended that the Manager discusses availability of medications with Boots Pharmacist. It is recommended that Temazepam is stored in a controlled drugs cabinet and a record kept of its administration in a bound book. It is recommended that staff attend formal abuse training to compliment the video training. It is recommended that the home puts together a refurbishment and maintenance plan. It is recommended that consideration be given for the provision of better laundry facilities. It is recommended that the system for monitoring the services provided by the home be developed further. Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Holmwood DS0000067560.V328743.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!