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Inspection on 18/07/07 for Holmwood Care Centre

Also see our care home review for Holmwood Care Centre for more information

This inspection was carried out on 18th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This is a large home that offers a good standard of personal, social and health care. There is easy parking and a pleasant entrance to the home. During office hours there is generally someone available in the office in reception. A call bell is fitted inside the foyer, close to the reception office so that when there is no one there the staff can be alerted should they be needed by a visitor. The residents and relatives say that the quality of the care they receive is good. A resident said `I am quite content.` And another said `I am well cared for`. A variety of in-house and community activities are arranged in which the residents can participate if they choose. Some residents prefer to stay in their rooms and the activities organiser visits them there. Religious and cultural needs are respected and support is given as requested. A vicar calls regularly and services are held for those who wish to attend.DS0000004119.V339964.R01.S.docVersion 5.2A varied choice of menu is provided and special diets and needs are catered for. Residents describe the food as good and wonderful. The staff come from a variety of countries as well as England and although their ability to understand and speak English varies, they are all able to communicate to some degree and English lessons at the local college are assisting those who need help. Some staff are shy but all are friendly and courteous. The staff are well recruited and checked to ensure they are suitable, and training is provided from the day they start work in the home. The residents say that the staff are kind and helpful. A doctor has commended the manager, senior nurse and the senior care assistants. The home is large and the facilities are generally good. Everywhere is clean and there are no offensive odours.

What has improved since the last inspection?

Since the last inspection the quality of record management has improved, as has the management of medication. This has ensured that the staff have the information they need to provide the care the residents need. New equipment in the dining room ensures that meals are served hot and according to the wishes of the residents. The cook has greater involvement with the residents and receives their opinions directly. Staff training has increased and progress is being made towards updating knowledge and skills that will benefit the residents and safety. Building work is in progress to improve some bedrooms and establish another lounge on an upper floor. The redecoration programme continues.

What the care home could do better:

Some residents have to wait for the full hoist to be available. It is suggested that the provision of such equipment is reviewed and increased if necessary so that residents do not have to wait an uncomfortable length of time. A review of the phone system should be undertaken and a modern system installed if appropriate to improve communication between the home and the community.DS0000004119.V339964.R01.S.docVersion 5.2Despite some improvements, the provision of storage space does not meet what is needed. There should be sufficient space on each floor so that residents and staff are able to move easily around the home and use the facilities without hindrance.

CARE HOMES FOR OLDER PEOPLE Holmwood Care Centre 25 Comberton Road Kidderminster Worcestershire DY10 3DJ Lead Inspector Yvonne South Unannounced Inspection 18th July 2007 08:30 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 DS0000004119.V339964.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. DS0000004119.V339964.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Care Centre Address 25 Comberton Road Kidderminster Worcestershire DY10 3DJ 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) 01562 824496 01562 822935 admin@holmwood.plus.com St Cloud Care Plc Mrs Angela Jean Butler Care Home 60 Category(ies) of Dementia - over 65 years of age (40), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (60), Physical disability (5), Physical disability over 65 years of age (60) DS0000004119.V339964.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Accommodation to be used for a maximum of 45 nursing places. Category PD is restricted to persons aged between 55 -64 years. The home may accommodate one named service user over the age of 50 years with learning disability (LD). 7th March 2007 Date of last inspection Brief Description of the Service: Holmwood Care Centre is a 60-bedded care home situated a short distance from the centre of Kidderminster. The home has 52 single rooms 43 of which have en-suite facilities and there are 4 shared rooms. Accommodation is provided on three floors with a passenger lift providing access to rooms on the upper floors. The home provides both residential and nursing care, with a maximum of 45 residents requiring nursing care to be accommodated at any time. Residents requiring nursing care are usually cared for on the ground and first floor with residents requiring residential care located on first and second floors. The home is owned by St Cloud Care Plc. and the registered manager is Mrs Angela Butler. The manager stated that the current scale of charges for accommodation and care were £1412 to £2272 per month. Additional charges were made at retail costs for personal purchases. DS0000004119.V339964.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection that incorporated information received by the Commission for Social Care Inspection since the previous key inspection, which took place on 06.02.06, a random inspection which took place on 07.03.07 and the information obtained during fieldwork on 18, 19, 20 July 2007. The fieldwork took place over thirteen hours, during which the inspector spoke to five residents and seven staff. Documents were assessed and a partial tour of the premises was also undertaken. The registered manager gave assistance. Prior to the fieldwork the home was asked by the Commission for Social Care Inspection (CSCI) to complete and return an Annual Quality Assurance Assessment (AQAA) document. Questionnaires were sent to ten residents, their representatives and their doctors seeking their opinions of the service. Eight responses were received from residents, three from representatives and two from General Practitioners (GP). The focus of this inspection was on the key National Minimum Standards and requirements and recommendations that arose out of the previous inspections. What the service does well: This is a large home that offers a good standard of personal, social and health care. There is easy parking and a pleasant entrance to the home. During office hours there is generally someone available in the office in reception. A call bell is fitted inside the foyer, close to the reception office so that when there is no one there the staff can be alerted should they be needed by a visitor. The residents and relatives say that the quality of the care they receive is good. A resident said ‘I am quite content.’ And another said ‘I am well cared for’. A variety of in-house and community activities are arranged in which the residents can participate if they choose. Some residents prefer to stay in their rooms and the activities organiser visits them there. Religious and cultural needs are respected and support is given as requested. A vicar calls regularly and services are held for those who wish to attend. DS0000004119.V339964.R01.S.doc Version 5.2 Page 6 A varied choice of menu is provided and special diets and needs are catered for. Residents describe the food as good and wonderful. The staff come from a variety of countries as well as England and although their ability to understand and speak English varies, they are all able to communicate to some degree and English lessons at the local college are assisting those who need help. Some staff are shy but all are friendly and courteous. The staff are well recruited and checked to ensure they are suitable, and training is provided from the day they start work in the home. The residents say that the staff are kind and helpful. A doctor has commended the manager, senior nurse and the senior care assistants. The home is large and the facilities are generally good. Everywhere is clean and there are no offensive odours. What has improved since the last inspection? What they could do better: Some residents have to wait for the full hoist to be available. It is suggested that the provision of such equipment is reviewed and increased if necessary so that residents do not have to wait an uncomfortable length of time. A review of the phone system should be undertaken and a modern system installed if appropriate to improve communication between the home and the community. DS0000004119.V339964.R01.S.doc Version 5.2 Page 7 Despite some improvements, the provision of storage space does not meet what is needed. There should be sufficient space on each floor so that residents and staff are able to move easily around the home and use the facilities without hindrance. 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. DS0000004119.V339964.R01.S.doc Version 5.2 Page 8 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 DS0000004119.V339964.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 was not assessed, as this service is not offered in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available and support is given to help people make a decision regarding admission to the home. A place is only offered after an assessment has been undertaken that indicates the home can meet the individual’s needs. EVIDENCE: In the Annual Quality Assurance Assessment (AQAA) document the manager said that: A variety of differently priced rooms were available in the home. Pre-admission assessment of needs were undertaken to check that they could be met by the service before anyone was admitted to the home. DS0000004119.V339964.R01.S.doc Version 5.2 Page 10 Copies of the brochure, Service Users’ Guide and Statement of Purpose were provided to prospective residents and supporters. During the fieldwork people arrived seeking a place for a relative. Good practice was observed. In the eight questionnaire responses received back from residents, people said that they had received sufficient information to help them make a decision regarding admission to the home. The three responses received back from relatives varied between ‘always, usually and sometimes’ being in receipt of sufficient information. Information provided to the CSCI indicated that the home was able to respond appropriately to emergencies and the deteriorating health of residents. The care records of four people were assessed. These indicated that a good assessment of general needs had been undertaken and were used in conjunction with the Social Service Community Care Assessment to make a decision on whether appropriate care could be provided, before a place was offered. The details in the older assessments were less complete than those now being undertaken. The improved assessment documentation ensured staff had the information and guidance they needed when a new resident arrived. Residents told the inspector that they were well looked after and they were receiving good care. DS0000004119.V339964.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The staff have access to information and guidance and ensure the residents receive the personal and health care they require. Medication is well managed so that the residents receive their prescribed drugs safely. EVIDENCE: In the AQAA the manager stated: ‘We have put an immense amount of effort into improving our care plans. They have been evolving as we gain more experience in using them. We encourage residents to be as independent as possible. We have a low incidence of pressure sores commencing in our home and a high incidence of healing those we inherit from other places. DS0000004119.V339964.R01.S.doc Version 5.2 Page 12 Vulnerable pressure areas are quickly identified and treated. Staff are trained to deal with wounds and correct pressure relieving equipment is available on many beds and chairs. Only one person in the home has developed pressure ulcers in the past twelve months. We offer a wide choice of GP surgeries to our residents. We encourage residents to access opticians, podiatrists and physiotherapists, as they are required. We have introduced, with some success, the Gold Framework standards for terminal care. Residents responded in the questionnaires that they ‘always’ or ‘usually’ received the care and support that they needed. Sometimes they had to ‘wait a while for the hoist, as there were not enough suitable ones’. Local doctors appreciated the calibre of ‘the manager and senior nurse and three excellent National Vocational Trained (NVQ) care staff’ but had some anxieties regarding some of the other nurses. The manager said that the people concerned were no longer in the employment of the home. The doctors also said that they had some difficulty regarding communication between the surgery and the home. It was often difficult to locate the senior member of staff they wished to talk to The manager said that she had had discussions with the doctors regarding their concerns and a new policy had been agreed that would address them. Unfortunately one of the difficulties was that the home only had one phone line and multiple extensions. This sometimes made it difficult to locate the person required. Then they had to come to the ground floor to return external calls they had missed, which caused further delay. It appeared that the home had outgrown the phone system that was installed. The care records that were assessed indicated that care plans were in place that described how a range of care and nursing needs should be met. Risk assessments were in place and care plans drawn up where necessary. Advice and guidance had been given to residents as to how risks could be reduced with their co-operation. Where this advice had been declined this was noted. Good records were maintained of health care visitors and consultations. These included doctors, social workers, chiropodists, wheelchair specialists, continence advisors, optical services, speech and language therapists, and dieticians. The advice and guidance was recorded. However it was recommended that it should also be incorporated into the relevant care plans so that staff worked consistently. DS0000004119.V339964.R01.S.doc Version 5.2 Page 13 The daily records had been well maintained but the night care records were very weak. There was little evidence that residents, or with their consent, their representatives, had been involved in the care planning process. It was agreed that the majority of residents and representatives, would not be able or wish to read through, review and sign each of their care plans each month. Therefore it was suggested that, for those people who did not wish to do this, each month contact be made with them to ensure that they were aware of any changes and check that they were happy with the care provided. This should be recorded. Most relatives were happy with the communication between the home and themselves. It was acknowledged that sometimes staff were not visible as they were assisting residents. However the call bells in the home meant that visitors could always contact and speak to a member of staff if they wished. Privacy and dignity was respected by the staff. They were observed to treat residents with sensitivity and courtesy. Doors were knocked on and staff waited for a response before entering. Some of the ladies used modesty blankets over their legs especially when it was difficult to re arrange clothes after using the full lifting hoist. It was observed that approved locks were not fitted to all bedrooms and ensuites as is considered to be good practice. These locks enable residents to be private when they wish without running the risk of becoming trapped. It was observed that the mail was delivered to the addressee un-opened and residents were able to make and receive private phone calls. DS0000004119.V339964.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to participate in a range of in-house and community activities so that they receive stimulation and interests. Different faiths are respected and assistance and support is given when necessary. A choice of good quality meals is offered and residents make their selections and enjoy their food. Good links and communication is maintained with relatives of the residents and they are able to visit whenever they wish. EVIDENCE: The manager stated in the AQAA that: ‘Residents receive an individual room visit from the activities co-ordinator on a regular basis. Regular church services of different denominations are carried out in the home. Lots of outside entertainment is purchased for the home. DS0000004119.V339964.R01.S.doc Version 5.2 Page 15 Varied diets are catered for. Menus are varied and food is of a high standard. We participate in community events such as Children in Need and Race for Life. Some residents attend day centres and group activity sessions. There is a monthly activity programme. Twice yearly house meetings are held for residents and families. Questionnaires are distributed twice yearly. Opinions, ideas, comments and questions can be raised and responded to. In response to some ideas and suggestions the bain-marie has been moved from the kitchen to the dining room so that meals can be served hot directly to the residents. A cinema room has been installed so that residents have access to ‘block buster movies’. A Government grant has been obtained and a sensory garden is planned. A series of summer outings are planned.’ The questionnaire responses from residents stated that there were usually activities arranged by the home that they could take part in. Limited information was obtained prior to admission regarding family and social interests. However subsequently care plans were made available in the care records relating to social information and interests. Records had been maintained for each individual that demonstrated that a wide range of group activities took place in the home and community. For example a very successful trip on the Severn Valley Railways had recently been enjoyed. Residents who preferred to stay in their rooms received personal visits from the activities co-ordinator. An activities programme was available and copies were given to the residents. The manager said that the new cinema had proved a great success. The records indicated that religious services were regularly held in the home for those who wished to attend and the manager confirmed that representatives of other faiths were contacted whenever needed. The home supported open visiting and the visitors’ book indicated that a steady stream of people came each day. In the questionnaires the residents said that they always or usually liked the meals. One person said that they were ‘Quite content’ and another that they ‘Would like more variety’. DS0000004119.V339964.R01.S.doc Version 5.2 Page 16 Relatives of people who needed special diets expressed some concerns. The manager had addressed these concerns. The cook said that special diets were provided for people needing liquidised, soft and pureed food, and diabetic diets. She met every resident when they arrived and completed a record of their likes, dislikes and special needs. This was then copied and one was placed in the resident’s file and the other retained in the kitchen. Each day the care staff offered the menu choice to the residents and the kitchen responded accordingly. Sometimes there was a glitch in communication but matters were always resolved. The new equipment in the dining room had improved the meal times and she appreciated being personally involved in the serving of meals and receiving feedback from the residents. Residents told the inspector that they enjoyed their meals. One person said that they were wonderful and another said that she was never disappointed. DS0000004119.V339964.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 inspected at least once during a 12 month period. 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. Residents and their representatives know how to raise their concerns and do so. Concerns are investigated and responded to. The staff recruitment process seeks to ensure acceptable staff are appointed and appropriate training is provided so that the residents are safe from harm. Unsuitable staff are not retained. EVIDENCE: The manager stated in the AQAA that; The home works to company and government policies and procedures to keep residents safe and protected from abuse. All staff are vetted to ensure they are fit to work with vulnerable people. There are a small amount of complaints considering the size of the home and the turnover. Complaints are investigated as soon as they are brought to the attention of the home and the service is improved in consequence. Positive steps are taken to ensure mistakes are not repeated. Expert opinion is obtained when necessary and apologies are made unreservedly when necessary. There is an awareness that documentation could be improved and staff confidence needs to be encouraged. Internal communication needs to be more effective. DS0000004119.V339964.R01.S.doc Version 5.2 Page 18 10 complaints were received by the home in the past twelve-months. They were all responded to within 28 days and 6 were upheld. It was observed that the complaints procedure was contained in the Statement of Purpose and Service Users’ Guide and copies were readily available. Residents said in the questionnaire responses that staff were always willing to listen and act on what they said. They usually knew who to speak to and how to make a complaint. One person said; ‘The staff are always willing to help’. Relatives said that they knew how to make a complaint and the service ‘usually’ responded appropriately. It was observed that the complaint record contained information regarding the complaints received and responded to. For example two had concerned communication difficulties with a member of staff. This person no longer worked in the home. One complaint concerned the slow attention to a necessary repair. The repair had been carried out. One concerned a privacy and dignity matter. This had been discussed with the resident, relatives and staff concerned. Three people had contacted the CSCI directly but did not want their names revealed or their concerns investigated as complaints. Therefore with their agreement the issues have been incorporated into this inspection. The inspector assessed three staff records and observed that application forms had been completed, references taken up and checks made with the Criminal Records Bureau (CRB) and of the Protection of Vulnerable Adults (PoVA) list. Two of the responses had been received after the candidate had commenced work. The manager was aware that this was not acceptable and confirmed that it no longer happened. Staff confirmed that they had received training relating to the protection of vulnerable people and knew how to respond to concerns and complaints. DS0000004119.V339964.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 at least once during a 12 month period. 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 a clean, pleasant environment that suits their wishes. However space is limited for storage and this impacts on the lives of residents as they move around and use the facilities in the home. Laundry facilities are congested and this raises the risks of cross infection. EVIDENCE: The manager stated in the AQAA that; ‘Residents are encouraged to personalise their rooms and make them individual. High levels of cleanliness prevent the spread of cross infection. Rooms are redecorated before being reoccupied. The environment is kept to a high standard of repair. DS0000004119.V339964.R01.S.doc Version 5.2 Page 20 A comfortable temperature is maintained in the home that can be adjusted to individual requirements. All rooms are fitted to a high standard of furnishings, fittings, and equipment which are repaired/replaced as required. In the past twelve months a small number of premier rooms have been developed. Faulty pipe work has been replaced throughout the home and a new boiler has been installed. Dining rooms have been upgraded. In the future it is planned that the shared rooms will be rebuilt as singles with en-suite facilities and a sensory garden will be completed.’ The residents responded in the questionnaires that the home was always fresh and clean. A partial tour of the home was undertaken. It was observed that the dining room had been redecorated and the curtains relined. Part of a dark alcove in the dining room had been converted into a store cupboard for large items such as hoists, wheelchairs and frames. This had reduced the space available for dining but it was accepted that because of the nature of the service offered there were always residents who needed or preferred to dine elsewhere. Unfortunately the new cupboard was not large enough. Two hoists were still stored in the dining room as the cupboard was full. A bain-marie had been purchased and hot meals were served directly to residents according to their individual preferences. The purchase of a second mobile bain-marie was planned so that those who preferred to dine in their rooms would also received their meals according to their wishes and as hot as required. A new lounge was under construction on the middle floor so that there were facilities on every level. A sample of bedrooms were assessed. The rooms had been personalised with the occupants’ personal property and those residents in their rooms said that they appreciated having their own property and treasures around them. In a vacant room the window latch was broken and there was no call bell. In another room the carpet edge with the ensuite flooring had been taped down as it had started to lift. This had made it safe but it was unsightly. DS0000004119.V339964.R01.S.doc Version 5.2 Page 21 Call bells were provided in other bedrooms, ensuites and rooms used by residents. All bells that were checked reached to the floor or were approximately one to two feet off the floor so that they could be reached if someone fell. The call bells ‘queued’ at busy times so that they appeared to ring continuously. However a member of staff explained that they were all answered as rapidly as possible. If a bell rang for more than seven minutes it went into ‘emergency mode’. Windows on the upper floors that were checked were fitted with retainers so that there was no risk of people falling out. Hot water taps in ensuites were fitted with temperature restrictors and were within safe limits. The water pressure of one hot tap was low and the flow was slow. The manager was informed. Storage facilities continued to be very limited. It was observed that in addition to hoists being stored in the dining room, wheelchairs were stored in the care office on the upper floor and bathrooms were also used to store hoists, commodes, laundry bag carriers etc. The décor showed signs of wear and tear in some places and the manager said that all would be done when the building work had been completed. A total refurbishment was planned to include all bedrooms. It was intended that in addition to redecoration, new carpets, curtains, lights and chairs would be provided. Maintenance was generally well managed. However many doors squeaked. It was observed that each floor was linked internally by phone for communication although the home had only one main phone line and external calls could only be made from the main phone on the ground floor. It was observed that the laundry was very full and congested. Access to the hand basin was obstructed. The basin was stained with lime scale and the tap was dripping. Personal protective equipment was available throughout the home. Communal bathrooms and toilets were supplied with liquid soap and paper towels and alcohol hand cleanser was provided to reduce the risks of cross infection further. DS0000004119.V339964.R01.S.doc Version 5.2 Page 22 The home was clean and fresh and there were no offensive odours. The manager said that ‘accidents’ were dealt with immediately they were identified. The training matrix and staff confirmed that training regarding infection control was provided. DS0000004119.V339964.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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. Staff are well recruited and receive training so that they provide the care the residents require. However the commitment to training needs to be continued so that the residents are not at risk from new staff that do not have the training and skills that are necessary. EVIDENCE: The manager stated in the AQAA that; ‘The home has a well-trained work force that provides good quality care for our residents. A good quality remuneration package is offered for staff that make a commitment to the home. Complaints against staff are fully investigated and there is no hesitation in dismissing staff when the occasion warrants it. There is a stable core of staff that have worked in the home for a number of years and there is a low level of complaints against staff. Staffing levels have been improved on all three floors. The training schedule has been markedly improved, and the majority of new staff have been retained. DS0000004119.V339964.R01.S.doc Version 5.2 Page 24 Some staff groups are not valued as much as they should be and the turnover in some areas needs to be improved. Working relationships between ethnic staff groups needs to be improved. There are 51 full and part time care and nursing staff and 14 ancillary staff employed in the home. In the past 3 months ten shifts have been covered by agency staff. Seven full time and fifteen part time staff have left the home in the past 12 months Staff ages range between 18 and 64 years with the majority being between 35 and 44 years. There are 49 female staff and 7 male staff. Of the 39 staff employed 11 have NVQ to level 2 or above and 23 staff are on courses. 83 of catering staff and 18 of care staff have training in safe food hygiene. There is a diverse ethnic range among the staff composed of white British, African, Indian, Asian peoples.’ The residents responded in the questionnaires that staff were always or usually available when needed and they would help if they could. Relatives considered that they usually had the right skills and experience to look after people properly. Some people had concerns regarding communication. The manager said that all the staff from abroad could make themselves understood, and understood others. Two of the Polish staff were attending English classes. 40 of the staff team were new due to recent resignations. The manager said that two staff had been disciplined and on the following weekend they decided not to arrive for their shifts. They were joined by two more of their colleagues. It had been impossible to obtain agency cover for so many at such short notice on a weekend. However all possible staff were asked to come on duty and had responded well. They had prioritised their work and ensured that the residents’ personal and health care needs were addressed and no one came to harm. The emergency was handled well. Three staff were interviewed by the inspector. They indicated that they had undergone an acceptable recruitment process and induction to the home and care practice. They were aware how to respond to a fire, if they received a complaint and if they had concerns regarding possible abuse of a resident. DS0000004119.V339964.R01.S.doc Version 5.2 Page 25 At the time of the random inspection there was an intensive commitment to update all training for staff. The manager said that this had suffered a temporary setback, as the member of staff appointed to take the lead had not achieved the home’s objectives. The AQAA indicated that only 9 staff had received training in infection control however during the fieldwork the manager said that this had increased to 22 trained staff. Nearly all of the staff had completed training in dementia care and a programme of health and safety training had commenced with 15 staff having completed the course. A training matrix was available and work was in progress to meet the training needs of all staff. DS0000004119.V339964.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 home is well managed and systems are in place to ensure the risks to health and safety are managed for the benefit of everyone in the home. EVIDENCE: The AQAA stated that; ‘The registered manager continues to update her knowledge on a regular basis and senior staff keep abreast of changes to legislation and how it affects the home. Staff are well trained and supported to reach their full potential. Records are kept up-to-date and stored securely. The home is managed in a fair and unjudgemental way. A quality assurance programme is well established. DS0000004119.V339964.R01.S.doc Version 5.2 Page 27 The company is run in a way that ensures it is commercially viable. The health safety and well being of residents, staff and visitors are paramount.’ The home has a stable management structure and is well managed. It was observed that the manager was competent and knowledgeable in her role. The Quality Assurance System was well organised and spread the audits throughout the year. This ensured that developments and improvements could be made when identified. The information obtained, for example regarding training, had been collated and was informing the training plan for the coming year. This quality assurance system was now being developed to link into and inform the AQAA required by the CSCI each year. Policies and procedures were in place and had been appropriately reviewed. Some needed to be re-typed and this task had been identified in the manual. The administrator said that no personal monies were managed by the home. All personal purchases were invoiced. When there was a planned outing monies were sometimes held in safekeeping. These were always receipted in and out and records were maintained. Records were well maintained and a monthly audit of accidents was undertaken so that any developing trends could be identified and addressed. The maintenance folder indicated that equipment and systems were appropriately serviced. The AQAA stated that ‘Equipment is appropriately maintained. PAT testing is due for review this month.’ The risk assessment manual was reviewed in February this year. The training matrix indicated that work was in progress to ensure all staff were up to date with health and safety training in core topics. The registered manager and the general manager undertook a fire risk assessment in October 2006. Other records indicated that the fire safety systems and alarms were regularly tested and checked, and staff were receiving training and drill practice. The handyman had undertaken the Fire Marshals course. DS0000004119.V339964.R01.S.doc Version 5.2 Page 28 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 3 X X N/A 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 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000004119.V339964.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP7 Good Practice Recommendations Residents or, with their consent, their relatives should be more involved in the care planning process so that the residents receive the care they need in the manner they wish. The provision of hoists should be reviewed so that residents are not kept waiting for an unacceptable length of time. 3 OP19 The telephone system should be reviewed to ascertain if it is suitable to meet the requirements of the home and those wishing to make contact with senior staff. 2 OP22 DS0000004119.V339964.R01.S.doc Version 5.2 Page 30 4 OP22 Consideration should be given as to how storage facilities can be further improved so that equipment is put away on each floor and residents and staff are able to move around and work un-hindered. 5 OP26 The laundry facilities should be reviewed to relieve congestion and improve access to the hand basin. Thus reducing the risks of cross infection. DS0000004119.V339964.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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