CARE HOME ADULTS 18-65
Holmwood Home 29 Worsten Drive Ewood Blackburn Lancashire BB2 4EG Lead Inspector
Jane Craig Unannounced Inspection 24th January 2006 09:00 Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 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 Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Holmwood Home Address 29 Worsten Drive Ewood Blackburn Lancashire BB2 4EG 01254 662827 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) Mr Anthony Samara Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th August 2005 Brief Description of the Service: Holmwood is privately owned by Mr and Mrs Samara, with Mr Samara taking responsibility for the day-to-day management of the home. Holmwood is registered to provide personal care for up to three residents with learning disabilities. Holmwood is a large detached house on a new residential estate of similar properties. The home is located on the outskirts of Blackburn town centre and is close to local shops and other amenities. There is a local bus service nearby. There are four bedrooms, each with en-suite facilities. A separate shower room is situated on the first floor. Communal space comprises a through lounge/dining room and a conservatory. There is a well equipped kitchen. There are gardens to the front and rear of the house with access to the canal towpath at the rear. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over half a day. The previous statutory inspection was done on 17th August 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of the inspection there were 3 residents accommodated in the home. The inspector spoke with all the residents about their experiences of living in the home and their views and comments form part of this report. Discussions were held with the registered person. A number of documents and records were viewed. Detailed notes were taken during the inspection, which have been retained as evidence of the findings. What the service does well: What has improved since the last inspection?
The induction programme for new staff had improved. Staff received training, which helped them to understand and meet the needs of the residents. Some staff were part way through NVQ training. When they complete the training there will be enough qualified care staff working in the home. The registered person had successfully completed the NVQ level 4 training in care and management. This provided him with a greater understanding of management issues, which benefited both residents and staff. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 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. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 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 Home DS0000057154.V278859.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the above standards were assessed during this inspection. Standard 2 was assessed and met during the inspection of 17/08/05. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Care plans provided staff with information about residents’ needs but the lack of updates may result in residents receiving inappropriate care. EVIDENCE: Care plans were drawn up following the resident’s annual review. Residents said the registered person talked to them about their plans. The plans set out needs, strengths and goals. Some directions for staff were clear and detailed. Others, for example how to meet personal care needs, were brief and did not ensure consistency of care. Reviews were carried out every two months. The review notes were detailed and provided information on the resident’s progress towards meeting goals and identified any changes in need. However, care plans were not updated in accordance with the reviews, which meant that staff might be following inaccurate or out of date directions. There were clear strategies for managing risks and any difficult behaviour. A number of documents in the residents’ care files were not dated or signed by the member of staff drawing them up. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The home’s policies and practices ensured residents’ rights were upheld. EVIDENCE: Written information was available with regard to care values and residents’ rights. Residents said they had privacy when they were in their own rooms. One said “I can stay here if I want to be by myself.” The registered person stated that although there were no hard and fast rules about getting up and going to bed, some routines were encouraged to assist residents to structure their day. Residents’ assistance with domestic tasks was recorded on their weekly programme. One resident said, “I like keeping my room nice.” Any restrictions placed on residents were agreed and noted in care plans and risk assessments. Staff interacted with residents in a friendly and respectful way and residents were relaxed and comfortable with staff. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Personal care was provided in such a way as to suit residents’ needs and preferences. Residents’ healthcare needs were identified and met. There were some shortfalls in the management of medicines, which may place residents at risk of harm. EVIDENCE: The policies and practices of the home supported residents to maintain their independence. Residents said they received as much assistance as they needed with their personal care. One resident said when he was having a bath “they just regulate the water.” Another said, “they only help me if I need it.” One resident needed increasing help with personal care but his plan had not been updated to reflect this. Staff monitored residents’ ongoing physical and psychological healthcare needs and appropriate referrals were made to other professionals. One resident said he had to go the hospital for check ups. Another said “I see the doctor if I need to.” The registered person said residents had an annual health check but there were no Health Action Plans on file. Residents had regular appointments with the dentist and optician.
Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 12 Residents had signed consent forms for staff to administer their medicines. Previous requirements to update medication policies and improve records of medication entering the home had not been actioned. MAR charts were up to date and complete but some handwritten amendments had not been signed or witnessed. Medicines were stored safely. Storage temperatures were monitored and found to be satisfactory. There was no excess stock. None of the staff had gone on to complete the medication training they were doing at time of the last inspection. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Staff received training in adult protection issues but the lack of accurate procedures may result in allegations not being dealt with appropriately. EVIDENCE: Staff received annual training in the protection of vulnerable adults. A copy of the Blackburn with Darwen protection of vulnerable adults procedure was available for guidance. The registered person was aware of the procedure for reporting any allegations to the adult protection team but, despite previous recommendations, the policy for the home had not been updated to reflect this. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the above standards were assessed during this inspection. Standards 24 and 30 were assessed and met during the inspection of 17/08/05. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Improvements to the induction programme meant that new staff received training to assist them to understand and meet residents’ needs. The targets for NVQ training had not been met which meant that there was a shortage of qualified staff. Lack of essential recruitment information about staff could potentially place residents at risk of harm. EVIDENCE: There had been improvements in the induction training since the last inspection. Records showed that the newest member of staff had completed a formal programme, which met the standards of the National Training Organisation. Assessment of competencies and certificates were retained on file. All staff had received update training in safe working practice topics. None of the care staff were qualified to NVQ level 2 at the time of the inspection. However, 2 staff were undertaking the course and the target of 50 will be reached on completion of this training. No new staff had been employed since the previous inspection. As required following the last inspection, the registered person had obtained references for the latest employee. However, other required information such as proof of identity and an employment history were not on the staff file. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 40 An experienced and appropriately qualified manager was in charge of the home. Systems were in place to enable residents to make their views known but there was no formal plan to assist development of the service. The lack of relevant, up to date policies and procedures meant that that staff did not have access to essential guidance. EVIDENCE: The registered person was also responsible for the day to day management of the home. He has many years experience in working with the resident group and has a nursing qualification. Since the last inspection the registered person had successfully completed the NVQ level 4 in care and management. The home held the investors in people award and the registered person had applied for assessment under the local authority quality management scheme. With the help of a member of staff residents had completed surveys asking their opinions about the facilities and services as well as staff and management. The surveys indicated that all residents were satisfied with the
Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 17 home and their lifestyles. This was confirmed by discussions during the inspection. One resident said, “I’ve never been happier than I am here.” Residents were also able to make their views known and make suggestions for change during residents’ meetings. There were no mechanisms for auditing and improving systems such as record keeping and care practices. There was no formal plan for how the service was to develop. A previous recommendation to review and amend the policies and procedures had not been actioned. Some of the policies seen were not individual to the home. They were not relevant or did not reflect current practice. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 18 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 X 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 X 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 2 X X X Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 19 Yes 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 Requirement Care plans must be updated as and when changes occur. (Timescale of 31/08/05 not met) Medication policies and procedures must be reviewed in line with relevant guidelines. (Timescale of 31/03/05 not met) Accurate records of medication entering the home must be kept. (Timescale of 01/03/05 not met) All staff responsible for handling medication must receive appropriate training. Recruitment practices must be improved. The required documents and information relating to staff must be obtained and retained on file. (Timescale of 31/08/05 not met) Timescale for action 31/01/06 2. YA20 13(2) 28/02/06 3. YA20 13(2) 31/01/06 4. YA20 13(2) 18 30/04/06 5. YA34 19 31/01/06 Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 20 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 YA6 YA6 YA19 YA20 YA23 YA32 YA39 YA40 Good Practice Recommendations Care plans should contain clear directions for staff as to how residents’ needs are to be met. Care plans and other care documents should be dated and signed by the member of staff drawing them up. Residents Health Action Plans should be kept with their care records. Handwritten amendments to MAR charts should be signed and witnessed. The protection of vulnerable adults policy should be amended to include accurate directions for reporting suspected abuse. 50 of care staff should be trained to NVQ level 2. The quality assurance systems should be further developed. Policies and procedures should be kept under review. They should be individual to the home and reflect current practice. Holmwood Home DS0000057154.V278859.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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