Inspection on 05/08/08 for Holmwood

This inspection was carried out on 5th August 2008.

CSCI found this care home to be providing an Poor service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holmwood 10/08/07

Holmwood 21/12/06

Holmwood 27/07/06

Holmwood 11/03/06

Holmwood 04/08/05

Holmwood 21/03/05

Holmwood 10/06/04

Holmwood 17/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Holmwood 39 Chine Walk West Parley Ferndown Dorset BH22 8PR Lead Inspector Martin Bayne Unannounced Inspection 10:00 5 August 2008 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.V367574.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. Holmwood DS0000026820.V367574.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 Manager post vacant Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2 double rooms Date of last inspection 10th August 2007 Brief Description of the Service: Holmwood Care Home is owned and managed by Mrs Gallagher, it is registered to accommodate a maximum of 13 older people 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 people accommodated on the first floor need to be mobile enough to manage the stairs. The home usually accommodates the more independent person, 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: £375 - £495 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 Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. We, the Commission carried out a key inspection of Holmwood residential home between 9:30am and 6:30pm. We were accompanied on this inspection by a contract monitoring officer from Dorset County Council. The aim of the inspection was to follow up on the 10 requirements and 1 recommendation made at the last key inspection of the home in August 2007, and to evaluate the home against the key National Minimum Standards for older people. We were assisted throughout the inspection by Mrs Gallagher, the Registered Manager and Provider of the home. During the inspection we spoke with five of the residents living at the home and also with three relatives who were visiting on that day. We also carried out a tour of the premises and looked at a range of records that the home is required to keep by Regulation. Information that assisted us in forming the judgements within this report was also gathered from the returned Annual Quality Assurance Assessment document, AQAA. At the time of the inspection there were nine residents accommodated in the home and we found that there were positive outcomes concerning their care and well-being. The poor rating for this home is the result of a failure by the management to address some of the requirements made at previous visits and a failure to comply with some of the standards for older people. Full details are reported in the main text of the report. What the service does well: We found that residents at the home had relatively low care and health needs that were being met by virtue of staff knowledge of residents. We found that residents were treated with respect and dignity. Residents are provided with a good standard of food. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 6 The home has a well-publicised complaints procedure and residents were confident that complaints would be investigated thoroughly. Holmwood provides a ‘homely’ environment for residents. The home has a long-standing staff team. Residents told us that they were well cared for and that their needs were met at the home. What has improved since the last inspection? What they could do better: Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 7 Although pre-admission assessments of residents needs are carried out prior to their being offered a place at the home. Records of these should record more detail to evidence that the home can meet the assessed needs. Where hand entries are made to medication administration records, a second member of staff should check and sign that the record is correct. A sample of staff signatures should be maintained of those staff who administer medication, so that it can be determined from the record who has administered medication. Concerning medicines requiring refrigeration, these should be stored in the fridge within a separate, lidded container to ensure there is no contamination with foodstuffs. Full records of medication administered to residents must be maintained with no gaps in the records. The Registered Manager should continue to investigate opportunities to meet residents’ individual aspirations in meeting social and recreational activities, and that records should be kept of this. We found that a resident had a ‘stair gate’ fitted at the entrance of their room that was being used to remind the resident that they should seek staff assistance when leaving their room. We recommend that the resident concerned, not just the relative, sign the document that had been written regarding this matter to evidence that the resident was not subject to restrictions. We recommended that Mrs Gallagher attend one of the training sessions run by the local council in adult protection. To meet good infection control standards liquid soap and paper towels should be provided in communal bathrooms. The home should retain the copy of the CRB until a key inspection with the Commission has been carried out, in line with guidance set by the Criminal Records Bureau, to ensure that satisfactory recruitment checks have taken place. The home must maintain a duty roster and an adequate of who has worked each particular shift. Mrs Gallagher should take action to ensure that a level of 50 be trained to the standard of NVQ level 2 or above. We found that staff had been trained recently in moving and handling, but we recommend that training is provided by an accredited trainer. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 8 We found that a new member of staff had just completed their induction training within a two-day period but we recommend that more in-depth training be provided and more time be allocated for inducting new members of staff. We found that staff were receiving day to day supervision from Mrs Gallagher, however formal supervision was being carried out. Staff must receive formal supervision in accordance with the National Minimum Standards. We found that not all incidents that should be notified to the Commission had been reported. We found that Mrs Gallagher had not completed the Registered Manager’s Award. 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 DS0000026820.V367574.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from their needs being assessed prior to their being offered a place at the home. EVIDENCE: We used the personal files of two residents who had been admitted to the home since the last key inspection, to track the records and paperwork that the home is required to keep as evidence of the care provided to residents. One of the residents who we tracked through the inspection had moved from another county to be nearer their relatives. Mrs Gallagher had received a Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 11 thorough, detailed assessment of the person’s needs from the local council involved in the placement. The relatives of the resident had also visited the home and been involved in choosing the placement. We spoke with the relatives of this person during the inspection and they reported that they had been very pleased with how their relative had settled and was being cared for at the home. They told us that the home met this resident’s needs and that they had peace of mind that their relative was being well cared for. The second resident who we tracked through the inspection had been placed through Social Services as an emergency admission. Mrs Gallagher told us that she had had a telephone conversation with the care manager involved in the placement, but had had to do the assessment of the person’s needs once they had been admitted to the home, as there had not been time to carry out a pre-admission assessment of the person’s needs. We saw that a full assessment had been carried out once the person had been admitted to the home and we were told that the home is meeting this person’s needs. We looked at the pre-admission assessment form that had been completed in respect of another resident admitted to the home. We found that the home uses a form that lists the areas of need, as detailed in the National Minimum Standards. We recommend however, that more detail be recorded, as comments recorded on the person’s pre-admission assessment form, such as, ‘Suffers from a minor physical problems’ and ‘....uses one or more aids’, concerning their mobility, does not provide sufficient information to determine whether the home can meet needs. We found that the home had a Service User Guide that is made available to residents or their relatives at the point of enquiry or when a resident is admitted to the home. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Whilst acknowledging that care and health needs of residents were being met, the current care planning system does not provide useful working tools to inform staff of how to care for residents. Improvements could be made to systems for administering medicines within the home. EVIDENCE: At the last key inspection two requirements were made under this section. The first was in relation to ensuring that residents’ assessment of need is kept under review and the second concerned the provision of accurate and clear information within care plans so that staff can meet residents’ identified needs. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 13 We looked at the care plans for the two residents we tracked through the inspection. We found that there was a photograph of the person within their personal records, which is good practice to assist new staff in identifying to whom the plan belongs to. Mrs Gallagher provided us with examples of where she had written additional information within care plans to meet the requirement concerning care planning. We found however, that the template being used for care planning was in fact more of an assessment form providing a detailed, comprehensive checklist of needs, with a place to add comments. Our view was that this form could be used to record a person’s assessment of need, from which care plans could be developed. We do recommend however, as with pre-admission assessments, more detail is recorded where there is an identified area of need. We were satisfied that this form met the requirement of providing an assessment of residents’ needs but was not adequate means to inform staff of how to care for residents. We found that the home currently accommodates residents with relatively low care needs and from speaking with Mrs Gallagher it was evident that she had in-depth knowledge about all her residents. With only nine residents accommodated and a long-standing staff team, it appeared that staff relied on their knowledge of residents, not care plans to look after the residents currently accommodated. Should the home accommodate a resident with rapidly changing or complex needs, staff would require clear instructions through care plans on how to meet the desired outcomes of residents. We saw on one of the care plans that the resident had signed their plan, which provided evidence that residents were involved in the development of care plans. Mrs Gallagher showed us a format for recording care planning that she had used in the past. Our view was that with some amendment and development, this format was more suitable to record care planning. The requirement concerning care planning therefore remains in place and a new deadline for compliance was set. We discussed with Mrs Gallagher the benefit of further training in care planning and risk assessment. Mrs Gallagher agreed to undertake training in this area. This will be followed up at future inspections. We saw that some risk assessments had been completed such as moving and handling risk assessments and a risk assessment for a resident who manages some of their medication. However, there was little to indicate within care plans the considerations of how to minimise the risk of harm to residents when delivering their care. We discussed how better risk management could be achieved, through incorporating within care plans the reason why staff should carry out tasks in specific ways. All of the residents we spoke with told of their satisfaction concerning the way they were cared for. They told us that their health needs were met with visits GP visits organised when unwell and how dental, chiropody and other health Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 14 care needs were arranged on their behalf. The relatives we spoke with corroborated residents’ views. Despite our concerns about the care planning, residents’ health needs were being met at the home. We looked at how medication administration was managed within the home. Mrs Gallagher told us of the procedure for administering medication and this was reflected in the policy and procedure for the home. We looked at the medication administration records for all the residents and we found a few gaps within the records. A requirement was made that full records must be maintained of all medication administered. We saw that any known allergies were recorded on the person’s medication administration record, which is good practice. We recommend however that where hand entries are made to medication administration records, a second member of staff checks and signs that the record is correct. We recommend that a photograph of the resident is put at the front of their medication administration record to allow new staff to positively identify the person concerned. We also recommend that a sample of staff signatures be maintained of those staff who administer medication, so that it can be determined from the record who has administered medication. We were shown where medication is stored in the home; this being three locked cabinet’s in the kitchen area. This is not an ideal location for medication storage and should the planned extension of the home proceed, better storage facilities should be considered. We also found that the home does not have the correct facility for storing controlled drugs in line with new Regulations. The home uses a unit dosage system for medication administration. We were shown that medicines requiring refrigeration were kept in a compartment within the main fridge in the kitchen. We recommend that these medicines are stored in the fridge within a separate, lidded container to ensure there is no contamination with foodstuffs. We also recommend for medicines with an expiry date, a record is kept of the date that they are opened to ensure that they are not used beyond this date. We were told that staff who administer medication have received training through the pharmacist or through the ‘care to train’ pack supplied through the pharmacist. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ social and recreational needs are assessed and in general these needs are met, however more could be done to provide stimulation for residents. A good standard of food is provided in the home. EVIDENCE: At the last inspection a requirement was made that residents be consulted about opportunities for involvement in meaningful daytime activities of their choice. We found that some information had been recorded concerning a person’s life history, so that social and recreational needs of residents could be ascertained. Mrs Gallagher told us that she had spoken with the residents about providing more activities but had not kept a record of this. Concerning communal activities, the home currently holds a bingo session in the home one afternoon a week and fortnightly ‘motivation to music’ sessions are arranged in the lounge. She told us that a second bingo session had been arranged each Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 16 week but this had not been popular with residents and so had been stopped. Residents we spoke with appreciated the activities provided but did not wish for any more communal activities to be arranged. We saw that the home had a large selection of puzzles, books and games available to residents within the lounge. One of the residents attends a day centre on weekdays. Another resident we spoke with told us that they enjoyed reading and doing crosswords, and that magazines were bought for them through the staff. We recommend that the home continue to investigate opportunities to meet residents’ individual aspirations in meeting social and recreational activities. We were told that many of the residents have a lot of contact with relatives, who take them out for the day. On the day of our visit, three residents were visited by relatives, and one was going out for the day. The relatives we spoke with told us that they were always made welcome at the home and could visit at any time. Concerning residents’ choice and control over their lives, we were told by the residents we spoke with that they were free to get up and go to bed when they chose and that the staff were very supportive. They also told us that there were no restrictions placed upon them. We found that one resident had a ‘stair gate’ fitted in the entrance to their room and we were concerned that this was being used as a means of restriction. We found however, that this had been a planned intervention involving the resident and their relative and was being used as a means to remind that resident that they should seek assistance from staff when leaving their room. We were told that the resident could open this gate by themselves and that it was not used to restrict them to their room. We recommend that the resident concerned, not just the relative, sign the document that had been written regarding this matter. We were told by the residents we spoke with that the standard of food provided was good and that there was a choice of meals each day. We saw the menus for the home and this reflected a varied and balanced diet. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 17 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 17 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well publicised complaints procedure, however more training in adult protection would ensure that the Registered Manager was fully aware of local ‘safeguarding’ protocols. EVIDENCE: The home has a complaints procedure and the residents we spoke with told us that they had confidence that their complaints would be listened to and responded to appropriately. Mrs Gallagher informed us that she had received one complaint since the last key inspection. This had also been looked into through adult protection procedures and the Commission was notified. The complaints procedure is detailed within the Service User Guide, which residents and relatives have access to. Concerning the training of staff in the protection of vulnerable adults, Mrs Gallagher informed that all the staff had received some training as part of their induction training. Mrs Gallagher also told us that she had bought a training video and was planning to use this as additional training for the staff. We Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 18 found however, that neither Mrs Gallagher nor any of the staff had been on accredited adult protection training. It was agreed with Mrs Gallagher that she would attend one of the Dorset County Council adult protection training sessions. This will be followed up at future inspections. We found that Mrs Gallagher had copies of the local ‘Safeguarding’ protocols. She was also able to us the correct procedures to be followed should there be suspicion of abuse. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. The home provides a ‘homely’ environment for residents, however the laundry area is below standard and improvements could be made to meet infection control standards. EVIDENCE: At the last inspection a requirement was made for one of the en suite showers to be fixed and also that procedures be put in place concerning management of the laundry. We found at this inspection that the broken shower had been fixed and there were systems for managing the laundry. As mentioned in the Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 20 report of the last key inspection, the home does not have an adequate laundry area, this being a washing machine in an enclosed cupboard area. We discussed with Mrs Gallagher the lack of hand washing facilities and it was agreed that a small sink in a cupboard down the corridor from the laundry area would be set aside for exclusive use of staff doing the laundry. Mrs Gallagher told us that should the proposed extension go-ahead, new laundry facilities would be provided. On the day of our visit we found that the home was clean and free from unpleasant odours. The home was in reasonable decorative order and furniture and fittings in a reasonable state of repair. We saw that work was being carried out at the front of the home to provide more parking and better access. We saw that staff are provided with gloves and protective clothing in the interests of infection control. We found however, that in communal bathrooms, soap and cotton towels were provided for hand washing. We recommend that liquid soap and paper towels be provided in communal bathrooms for better infection control. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 21 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. Residents are potentially put at risk by not adhering to all the recruitment checks required by Regulation and through staff not being fully trained. EVIDENCE: At the last inspection two requirements were made concerning this section of the report. Firstly that all of the recruitment checks as listed in Schedule 2 of the Regulations be complied with, and secondly that staff receive training appropriate to the work they carry out. A recommendation was also made that the home achieve a level of 50 of staff are trained to NVQ level 2 or above. We looked at the recruitment records for one member of staff who had been recruited to the staff team since the last key inspection. We found that a criminal records bureau check, CRB, had been obtained before the person started working in the home. We recommend however, that the home retain the copy of the CRB until a key inspection with the Commission has been carried out, in line with guidance set by the Criminal Records Bureau. In some Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 22 other respects the requirements of Schedule 2 had not been complied with; namely, there was no proof of identification of the worker within the recruitment records, the applicant had not supplied a full employment history and there were no written references obtained in respect of this person. We did however see a record of two telephone references. In view of this noncompliance, a Statutory Enforcement Notice may be served. We asked to see a copy of the duty roster. Mrs Gallagher told us that she did not have a duty roster, as the staff worked the same shift patterns each week. She told us that she could evidence who had worked particular shifts, as she had a record in respect of the home’s payroll. It is a requirement that the home maintains a duty roster and that an adequate record is kept of who has worked each particular shift. We were told that between 8:30am and 8:30pm there were always two staff on duty within the home and that during the night-time period there was one awake member of staff and one member of staff who carries out a sleep in duty. On the day of our visit we saw that the day staffing was being provided as reported. Concerning the level of staff trained to NVQ level 2 or above, we were informed through the AQAA that 25 of the staff had achieved this level of training. It is recommended that Mrs Gallagher take action to ensure that this level is brought to 50 , in line with the Standards for older people. At the last key inspection it was found that not all the staff had been trained in basic food hygiene. We found at this inspection that all staff had received his training in May 2008. Mrs Gallagher told us that she had provided training to the staff on privacy and dignity in July of this year. Mrs Gallagher also informed that all the staff had been provided with update training in moving and handling. We found however that this training had not been given by an accredited trainer and it is recommended that all staff must receive this training by an accredited trainer. We also found that there were insufficient staff trained in first aid. We saw that the new member of staff had received induction training compliant with ‘Skills for Care’, however this had been carried out over a twoday period. In view of the fact that this person had taken a break in their career, this was an inadequate time to provide all of the induction training. It is recommended that more in-depth training be provided and more time be allocated for inducting new members of staff. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 23 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 36 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor record keeping and management of the home has meant failure to comply with Regulations governing running of a care home that could lead to residents being at risk of harm. EVIDENCE: Mrs Gallagher has owned the home for many years and has previous experience in hospital management. She told us that she had started training towards the Registered Managers Award, however the firm providing this Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 24 training had become insolvent and so she had not finished this training. A requirement was made that Mrs Gallagher complete the Registered Manager’s Award. The failure to comply with the requirement concerning staff recruitment is reflected in the poor rating for this section of the report, in line with the key lines of regulatory activity document, KLORA. Mrs Gallagher acknowledged that the staff were not receiving formal supervision in line with the standards of older people, although the staff receive day-to-day supervision of their work as Mrs Gallagher works alongside the staff in supporting residents. It is required that staff receive formal supervision in accordance with the National Minimum Standards. The returned AQAA informed us that one resident had died in the home within the year; however we did not receive a notification, as required under Regulation 37 of the Regulations. This was discussed with Mrs Gallagher and a requirement was made that all deaths within the home be notified to the Commission. We discussed with Mrs Gallagher our findings concerning the many deficiencies in the way the home was being managed. Mrs Gallagher was very open with us and told us that her main interest was in providing good hands-on care to residents and that she was not so motivated by the management side of the business. She told us that in the long-term, should the planned extension proceed, she would like to appoint a Registered Manager. She agreed that in the meantime she would seek outside assistance in setting up management systems to ensure that National Minimum Standards and the Regulations are complied with. Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 25 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 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 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 1 Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 26 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. 1. Standard OP7 Regulation 15 Requirement Care plans must be more accurate and give clear information about what action staff need to take in order to meet peoples’ care needs, including mental health needs and skin care. This requirement is repeated from the inspection of Aug 2007. 2. OP9 13 (2) The home must provide a controlled drugs cabinet that meets new regulatory requirements. Full records of medication administered to residents must be maintained with no gaps in the records. A copy of the duty roster must be maintained of persons working at the home, and a record of whether the roster was actually worked. All required pre-employment checks, as listed in Schedule 2 must be completed before staff DS0000026820.V367574.R01.S.doc Timescale for action 01/09/08 15/09/08 3. OP9 13 (2) 01/09/08 4. OP27 Schedule 4 (7) 01/09/08 5. OP29 19 31/10/08 Holmwood Version 5.2 Page 27 are employed. This is a repeated requirement from the last inspection in Aug 2007. 6. OP30 18 Staff must receive training appropriate to the work they carry out. Mrs Gallagher must complete the Registered Manager’s Award. It is required that staff receive formal supervision in accordance with the National Minimum Standards. Deaths, illnesses and other events must be notified to the Commission as detailed in Regulation 37. 31/10/08 7. 8. OP31 OP36 10 (2) 18 (2)(a) 01/01/09 01/09/08 9. OP38 37 01/09/08 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 OP3 Good Practice Recommendations 1 We recommend that records of pre-admission assessments should record more detail to evidence that the home can meet the assessed needs. We recommend that more detail be recorded where there is an identified area of need in the assessment form. We recommend that a sample of staff signatures be maintained of those staff who administer medication, so that it can be determined from the record who has administered medication. We recommend that medicines requiring refrigeration are stored in the fridge within a separate, lidded container to ensure there is no contamination with foodstuffs. DS0000026820.V367574.R01.S.doc Version 5.2 Page 28 2. 3. OP7 OP9 4. OP9 Holmwood 5. OP9 6. 7. 8. OP9 OP12 OP10 We recommend however that where hand entries are made to medication administration records, a second member of staff checks and signs that the record is correct. We recommend for medicines with an expiry date, a record be kept of the date that they are opened to ensure that they are not used beyond this date. We recommend that the home continue to investigate opportunities to meet residents’ individual aspirations in meeting social and recreational activities. We recommend that the resident concerned, not just the relative, sign the document that had been written regarding the use of a ‘stair gate’ at the entrance to their room. We recommend that Mrs Gallagher attend training in adult protection from an accredited provider.. We recommend that liquid soap and paper towels be provided in communal bathrooms for better infection control. We recommend that action be taken to ensure that the home has a level of 50 of staff trained to NVQ level 2 or above, in line with the Standards for older people. We recommend that the home retain the copy of newly appointed staff’s CRB until a key inspection with the Commission has been carried out, in line with guidance set by the Criminal Records Bureau. We recommend that all staff receive moving and handling training by an accredited trainer. We recommend that a sufficient period of time be allocated for staff to complete induction training. (A twoday period not being sufficient). 9. 10. OP18 OP26 11. OP28 12. OP29 13. 14. OP30 OP30 Holmwood DS0000026820.V367574.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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