Inspection on 08/01/07 for Holmwood Residential Home

This inspection was carried out on 8th January 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.

Other inspections for this house

Holmwood Residential Home 21/12/05

Holmwood Residential Home 22/07/05

Holmwood Residential Home 24/01/05

Holmwood Residential Home 31/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Holmwood Residential Home 37 Upper Olland Street Bungay Suffolk NR35 1BD Lead Inspector Deborah Kerr Unannounced Inspection 8th January 2007 10:00 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 Residential Home DS0000024420.V326857.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 Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Residential Home Address 37 Upper Olland Street Bungay Suffolk NR35 1BD 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) 01986 892561 01986 896030 sandra@holmwood-bungay.co.uk Mr Nicholas John Willoughby Sheldrake Mrs Sandra O’Grady Care Home 32 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (32) of places Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st December 2005 Brief Description of the Service: Holmwood is registered to provide care for up to thirteen people with a diagnosis of dementia and older people. It is situated in the small market town of Bungay. The home was formally the Holy Trinity Rectory and was purchased by the Sheldrake family in 1977. The original building has been significantly extended twice since 1992 and now offers accommodation for a maximum of thirty-two residents. During the last two years a programme of refurbishment has taken place providing a well maintained, attractive and comfortable home whilst retaining a lot of its old charm and period features. The most recent phase of refurbishment to be completed is the original former entrance hall and stairwell. The home is set in well cared for gardens and is close to local shops and amenities. A detailed statement of purpose, colour photographic brochure and a service user guide provides detailed information about the home, the services provided and access to local services. Each resident has a contract of terms and conditions; which reflect the fees and how much they are expected to pay per month. Fees are calculated depending on the needs of the resident and range from £331.00 – £475.00 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries, receipt of daily newspapers and any transfers to hospital. If assistance is required the cost of this will be invoiced to the resident separately. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over eight and three quarter hours during a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 11 residents ‘Have your say about’ and 9 relatives/visitors comment cards. Time was spent talking with 10 residents, 3 staff, 2 visitors and a district nurse. The registered manager and the deputy manager were available throughout the inspection. A number of records were inspected including those relating to residents, staff, training, medication, quality assurance and a selection of policies and procedures. What the service does well: What has improved since the last inspection? A requirement was made at the previous inspection for all staff employed in the home, including those from abroad must have the appropriate police checks in place before commencing employment. Staff files seen confirmed that all necessary paperwork had been obtained. The second phase of refurbishment of the home has been completed. The interior and exterior of the home is of a high standard and provides residents with excellent accommodation. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is excellent. Prospective residents can expect to be provided with detailed information about the home and can expect to receive information, which is available in a suitable format to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed statement of purpose, which has been reviewed and updated to clarify that the home is registered to provide care to thirteen residents with a diagnosis of dementia. The home’s brochure includes the service user guide, which contains information about the home and the services provided. There are several residents living in the home with a visual and/or hearing impairment. Discussion with the manager confirmed they had been in contact with a company to produce this information on a disc which prospective resident will be able to view and/or listen too. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 9 Three residents’ personal files and care plans were inspected to track the level of care and support required. Each resident had a daily living and needs assessment completed prior to admission; these were very detailed and provided information about the resident’s previous history, current health, personal care and general well being. These formed the basis of the residents care plans. Staff spoken with had good knowledge of the individual needs of the residents. The home was registered in 2006 to provide care for thirteen people with dementia. Currently there are eight residents diagnosed with dementia living in the home. The home’s manager is in the process of visiting other services to gather ideas and information to further develop the service offered to residents with dementia living at Holmwood. Training records reflected that staff have attended a range of training to meet the particular needs of the residents, which include dementia awareness and the provision of activities in the care setting. Resident’s files contained a written contract setting out the terms and conditions of residence, including a trial period, the method of payment and their current fee. These were being reviewed and updated annually. Several residents have recently moved into the home and spoke positively about their experience. They felt they had received a warm welcome and were getting to know their way around and the other residents. A relative commented they had visited the home unannounced on several occasions and at different times and always found the management and staff very accommodating. Residents spoken with confirmed they had been given the opportunity to visit the home. One resident confirmed, “I looked around the home before moving in. I was not happy about moving into residential care, but recognised I was no longer safe at home, Holmwood is the best there is” another resident commented “I have been made to feel really welcome and enjoy being at the home, I made up my mind about moving into the home. I received a brochure, with a picture of the home and details of an advocacy service”. The home does not provide intermediate care; subsequently this standard is not applicable. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10,11, Quality in this outcome area is good. Residents can expect to have their health care needs fully met and have their dignity and privacy respected, however, cannot expect to be protected by the home’s procedure for administering medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were inspected. Each contained a current photograph of the resident together with their personal details including next of kin and other important contacts. The plans were divided into fourteen sections covering all aspects of the resident’s health, personal and social care needs. Care plans include long and short-term goals, which identify the level of assistance required by staff to support the resident to achieve their goals and maintain their independence. These are supported by individual risk assessments with particular attention to moving and handling and falls. Details in the care plan confirmed these were being reviewed on a monthly basis. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 11 Daily notes reflected that the health and well being of residents was being monitored and where required intervention from other health professionals was obtained. For example, a monthly audit conducted by the deputy manager reflected one resident had a reoccurring high number of falls. In November the audit reflected the resident had had 14 falls. The daily notes reflect the resident was referred to a falls clinic and as a result has been sent for further tests and a referral to a consultant has been made. In the mean time to protect the resident from further falls the home purchased a pressure-sensing mat, which alerts staff via the call system that the resident has got out of bed and is moving around their room. Regular visits were documented showing residents had regular access to the general practitioner (GP), district nurse, and chiropodist and in the case of one resident an appointment had been made with an occupational therapist (OT) to assess their wheelchair. A district nurse visits the home daily to administer insulin injections and commented on the nice atmosphere within the home. They found staff to be helpful and willing to follow their instructions for the prevention and treatment of residents with pressure areas. They felt the district nurse team and the home had a good relationship and that the home are quick to consult them if they have concerns about a resident. They spoke of an increase in pressure area care lately, as a number of residents had been admitted to the home with existing pressure areas. They confirmed that residents were provided with pressure relieving equipment either by the home or by the district nurses where more specialised equipment was required. The senior on duty demonstrated the process of administering medication. The Monitored Dosage System (MDS) is used and each blister pack had a front sheet with the individual’s details and a photograph of the resident for identification purposes. The senior explained that responsibility for medication is split between four seniors; each is responsible for 7-8 residents for the ordering and receipt of the medication. The quantity and date medication is received was seen entered on the Medication Administration Record (MAR) charts and signed by the senior and another member of staff. Generally the process of dealing with medicines is well managed, however there were some errors on the MAR charts, one resident’s evening medication on the 5th January had not been signed for, the medication had been taken out of the blister pack indicating the medication had been administered or soiled, there was no explanation recorded on the MAR chart to reflect this. Additionally another residents cream had not been signed for the 2nd and 3rd of January. The controlled drugs book confirmed the home currently have five residents prescribed controlled drugs. The senior explained that at the end of each shift an audit of the controlled drugs was undertaken between the change over of senior staff. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 12 This is to countercheck and sign to acknowledge the stock of controlled drugs for each resident. A check of one resident confirmed the number of controlled drugs held was accurate. Medication is locked in a room, which also provides space for a small fridge. Evidence was seen that the home does not hold large stock of medicines. The deputy manager conducts a monthly audit of medication to monitor the process to ensure medication is being administered safely and in line with the homes policies and procedures. The senior advised that the pharmacist completes an audit of the home’s medication procedures; the last official visit was in March 2006, with no recommendations. The senior confirmed they had received training for the administration of medication and felt supported by the management team. Residents were observed being called by their preferred name and felt that staff respected their privacy. Staff were observed knocking and waiting before entering resident’s rooms. The interactions between residents and staff were observed to be friendly and appropriate. The palliative care and end of life needs of the residents needs to be discussed and documented in their care plan so that they are assured at the time of their death staff will treat them and their relatives with care sensitivity and respect. Following the inspection the manager has forwarded documentation to the Commission for Social Care Inspection (CSCI) to demonstrate how they intend to collate this information. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 13 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 excellent. Residents can expect to live in a home that supports a lifestyle that matches their expectations and can expect to receive a good standard of fresh and appealing food with a wide variety of choice as part of their daily diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A newsletter has been produced providing information of future activities and acknowledges contributions from everyone making Christmas an enjoyable occasion. The newsletter welcomes five new residents into the home and requests ideas from for future outings, naming boat trips, gardens and the seaside as suggestions already made. Regular scheduled activities for the New Year are advertised, which include games and quizzes of choice and armchair exercises. Additionally there are word games and crafts arranged two days a week. The newsletter reflected residents had enjoyed a pantomime of Jack and the Beanstalk, a Christmas buffet and a shopping trip to Castle Mall. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 14 Other activities include various musical entertainers visiting the home and organised trips into town, walks and outings of resident’s choice. Residents spoke of visiting Norwich castle and a boat trip on the river to Great Yarmouth. Residents are supported to access religious services, a communion service is held in the home and transport is provided for residents to access local churches and church society events. A resident told the inspector that they had recently completed a charity swim to raise money for the Alzheimer’s society; they had been supported by their relative and the manager whilst swimming lengths of the pool and had raised £600. Residents spoken with confirmed that they were free to spend their time as they wished. Their chosen activities ranged from undertaking daily household chores to spending time privately in their rooms, writing letters, reading, drawing and painting, listening to music or going for walks. One resident commented that they missed home baking. This was discussed with the activities co-ordinator who is introducing making bread as an activity. Another resident was enjoying their morning coffee waiting to be joined by two friends. They spoke of taking part in craft sessions. The home has an artist and a craft activity professional who visits the home twice a week. Comments taken from relatives comment cards confirm the home provides residents with a service that meets their expectations, for example” I have always found the staff caring and welcoming at all times, nothing is too much trouble. There is always someone available to discuss any troubles and concerns” and “Holmwood is really lovely and peaceful, my relative is very happy there, staff are lovely, I cannot speak highly enough of them”. Currently the home is providing support to eight residents with a diagnosis of dementia. These residents were observed relaxing and eating their meals in the smaller lounge separate to the other residents. The care and support provided to residents is of a high standard and the manager confirmed they are proactively seeking information and advise of how to further develop this service focusing on promoting resident’s dignity, inclusion in daily life within the home and what additional measures they need to take to meet the diverse needs of these residents. To ensure these residents are given opportunities for stimulation the manager has implemented additional hours for a companion to provide one to one support undertaking individual reminiscence and life story work three afternoons a week. The activities co-ordinator has attended training for provision of activities in a care home setting. Residents confirmed they are able to receive visitors at any time in private or in communal areas. Visitors included relatives, friends, old neighbours, and a hairdresser. Residents are invited to attend meetings to discuss issues about the home. The minutes of the last meeting in October 2006 reflect that issues such as outings, entertainment, maintenance issues, menus and food were discussed. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 15 Two new residents were spoken with to obtain the views of moving into the home, they were both very positive about the experience, commenting that they have nice rooms with en suite facilities and that the food is incredible. One of the residents commented “I am very lucky, the home is perfect for me as it is near to my relatives and I am able to go out with them on a regular basis”. Ten residents were spoken with during the inspection and all stated that they had enjoyed Christmas at the home, the home had been beautifully decorated and the food was very good. They were unanimous in their opinion that food was generally of a high standard and that they were able to choose where to eat their meals, either in the in dining room or their own room. One resident commented, “The home is marvellous, better than a hotel and the food and staff are lovely”. Residents are encouraged to take responsibility for their own finances. Seven residents are supported to handle small amounts of money kept at the home for purchasing small day-to-day items; these residents chose to have their money locked in a safe in the office. Each resident has a separate moneybag, which is individually labelled and has a folder with an account of their spending record; all entries and withdrawals are recorded and two signatures obtained. The balance of one resident’s monies was checked against their spending record and found to be accurate. All residents’ have a lockable cabinet in their room for locking small amounts of money and personal items. The lunch menu consisted of roast chicken breast or crispy chicken, accompanied by sauté potatoes, carrots, peas and green beans, followed by a choice of tiramisu or ice cream and banana. The cook explained there are always alternatives available, such as a selection of cold meats and country bakes. They were aware of specific dietary needs of the residents and confirmed they catered for diabetics using sugar substitutes. All food is freshly prepared and cooked on the premises including homemade cakes. Food seen was nicely presented and looked appealing and appetising. Mealtimes were seen to be a social occasion with people engaging in conversation during their meal. The kitchen is a large and spacious area, which allows plenty of room for the cooks to store, prepare and cook food. An environmental health officer had visited the home to discuss the use of the Better Food, Safer Business pack. This information was seen to be in operation and being used to document and monitor the temperatures of food delivered to the home, cooked and served and storage in fridges and freezers. Temperatures were seen to be within the safe recommended limits as recommended by the Food Standards Agency. Fresh meat, fruit and vegetables are delivered to the home from local suppliers. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 16 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, Quality in this outcome area is good. People using the homes complaints procedure can expect to have their concerns listened to and receive an appropriate response, however cannot expect to be protected from the possibility of abuse until behaviour management strategies are agreed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has detailed policies and procedures in place for protection of vulnerable adults, whistle blowing and complaints. These have all been reviewed during 2006. The complaints procedure sets out a detailed response to any complaints within five days of receipt of the complaint. It also refers residents and relatives to the Commission for Social Care Inspection (CSCI) and gives the address and telephone number. As already mentioned consideration should be made for this information to be made available in a format suitable for the people with a visual and /or other sensory impairments. A copy of the complaints procedure is displayed on the notice board in the entrance hall along with a number of cards and letters of compliments thanking the home and staff for “The kindness shown to our relative in the last days leading up to their death”. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 17 The complaints log identifies that a complaint was raised during a residents meeting in March 2006. One resident with reference to a number of issues made the complaint. Entries in the complaint log identified that each issue had been dealt with separately and fed back to the resident who appeared to be happy with the outcomes. Residents and staff spoken with were confident if they were unhappy about something they would be able to speak with the manager. Staff were aware of their responsibilities to report any suspicion or evidence of abuse to the manager and to the customer first team in line with the Suffolk vulnerable adult protection committee (VAPC) inter agency policy. Two staff are authorised as trainers to provide adult protection training in house to staff. Training information reflected that all staff have received up to date refresher training between June and October 2006. The daily notes of one resident identified there have been occasions where they have been verbally and physically aggressive towards staff. This was confirmed during discussions with a member of staff. Although they were clear how they would deal with the situation, there was no set behavioural plan with strategies outlining how staff should consistently manage the resident’s behaviour. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 18 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): 19,20,21,22,24,25,26, Quality in this outcome area is excellent. Residents can expect to live in a home that is decorated and presented to a high standard, which is safe, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Holmwood is situated within walking distance of Bungay town centre, a library and a local community centre. The house is beautifully decorated, comfortable and has been through a process of refurbishment. The interior and exterior has been decorated to a high standard, retaining some of the features of the original older building, providing residents with excellent accommodation. The most recent decoration includes the original former entrance hall, corridors and stairwell. The gardens are attractive and nicely kept. To the rear of the property there is a patio with a water feature. Ramps from the house to the garden have been installed to aid access and egress for residents using wheelchairs and other mobility aids. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 19 On entering the home there is a noticeable happy, relaxed and homely atmosphere. Residents were observed moving freely around the home involved in their daily routines. Vases of fresh flowers, plants and bowls of fresh fruit had been placed in communal areas and residents rooms, these additional touches helped to create a ‘homely’ environment. The home offers seventeen single en-suite rooms and two double en-suite rooms. They also provide one double and nine single rooms that do not have en-suite facilities. There are two fully assisted bathrooms and six toilets for communal use. All bathrooms and toilets have been fitted with grab rails. The kitchen and dining room provide large and spacious facilities for mealtimes. The home has two lounges that residents can choose from. Other facilities include a laundry and an old bathroom has been made into a hairdressing salon. Residents spoken with were happy with their rooms, one resident commented, “ I like sitting in my room as I overlook the garden and can watch the birds”. All residents’ bedrooms are fitted with a call bell, door lock and lockable cabinet for personal items. Residents are offered the opportunity to hold a key to their room. Rooms were nicely decorated and evidence was seen that residents had brought their own possessions with them to personalise their rooms. Fixtures and fittings in and around the home are domestic in nature and of good quality. Moving and handling equipment, is stored out of the way leaving corridors, bedrooms and bathrooms clutter free. The home was found to be clean, bright and tidy with no unpleasant odours. Staff had access to appropriate hand washing facilities of liquid soap and paper towels in the bathrooms and toilets where they might be required to provide assistance with personal care. Staff were observed to wear appropriate protective clothing when assisting residents with personal care. Laundry facilities lead out into a courtyard so that laundry can be hung out to dry in good weather. Both washing machines have a sluice cycle and staff use red dissolvable bags to separate and deal with soiled linen. Water temperatures are being recorded; these were tested and found to be within the safe recommended temperature of near to 43 degrees centigrade at various intervals during the day. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 20 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, Quality in this outcome area is excellent. Residents can expect to be supported by a staff team in sufficient numbers who have the skills and knowledge to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Homlwood has 26 staff in total made up of 16 care staff, which includes 5 seniors, 4 domestics’, 2 cooks, 3 kitchen assistants and 1 administrator, plus the deputy and the manager. The staff roster reflected that there is a senior, plus 2 care staff on the early shift between 7-2pm, with additional support between 7-10.30am. The late shift has a senior with 2 care staff between 2 – 9pm. There is two waking night staff on duty between 9pm – 8am. Additionally there is an activities co-ordinator, cook, kitchen assistant, 3 domestics and a laundry assistant. A member of staff was working 10.30-12.30 to provide additional support to residents with dementia. The home does not use agency or temporary staff. Residents spoken with confirmed there were sufficient staff to meet their needs and confirmed that staff responded promptly to their call bells when they required assistance. Training records and files reflected a commitment to staff training and development. Seventy five percent of staff have obtained a National Vocational Qualification (NVQ) at either level 2 or 3. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 21 All staff attend core training on a continuous programme throughout the year which includes moving and handling, health and safety, fire safety, first aid, food hygiene and protection of vulnerable adults. Additionally, to ensure that staff have the knowledge and skills to care for specific needs of the residents all care staff have completed certificate in dementia awareness and staff confirmed they had attended in house training sessions relating to Parkinson’s disease and diabetes. Two staff attended an employment law seminar and one senior member of staff attended a foundation in management course. Three of the catering staff attended training to comply with the updated food standards regulations. Senior staff and the manager and deputy have commenced a correspondence course for safe handling of medicines through a local college. The manager provided an example of an induction-training pack for new staff. This is provided by an external training company, a tutor visits the home for an initial introduction and sets the new employees target dates to complete units. These are put forward for assessment and certification on completion. Three staff files seen confirmed the home operates a thorough recruitment process, which includes obtaining all the appropriate paper work including police and protection of vulnerable adults (POVA) checks and in the case of overseas workers work permits and police checks. Staff are also issued with a handbook, which contains information about their terms and conditions of employment and professional code of conduct. Staff had clearly defined job descriptions outlining their roles and responsibilities. Staff spoken with confirmed there is sufficient staff on duty to meet the needs of the residents. They commented the majority of the staff had worked together for a long time and collectively have a range of experience. They were clear about their roles and demonstrated a good knowledge of the residents. They found the manager and deputy supportive and approachable and received a lot of training. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,37,38, Quality in this outcome area is good. Residents can expect to live in a home, which is effectively managed, however to protect their safety a risk assessment of unguarded radiators must be completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has the necessary qualifications and relevant experience caring for older people. They are a registered nurse and registered midwife with a master’s degree in health and sciences and a bachelor (honours) degree. They have also completed the National Vocational Qualification (NVQ) level 4 managers award and continue to broaden their knowledge through additional training. They have completed a trainer course to cascade training in house to staff for the protection of vulnerable adults and is a trained risk assessor. They have recently commenced training for the safe administration of medicines. Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 23 The manager has a strong commitment to providing a good service in line with the home’s aims and objectives. They were clear of the future development and progression of the services they provide. This is based on sound financial viability and they demonstrated that they are continually seeking feedback about the quality of the service currently provided using an effective quality assurance process. A quality policy demonstrates that the home aim to provide a quality service through competent and well-trained staff and consultation and involvement of residents using satisfaction surveys and meetings. Surveys are sent to relatives and visiting health professionals. The inspector was shown the most recent surveys obtained from health professionals and relatives. Feedback was very positive about the efficiency of the staff and management of the home. An example of comments made by relatives confirmed that the home achieves its aims and objectives, for example, “The care and general running of the home are impeccable” and “Excellent, my relative is cared for very well, ten out of ten” and “Thank you to all the staff and management who have always made my family welcome”. Staff, residents and relatives spoken with confirmed the manager is supportive and approachable. Regular staff, residents and relatives meetings take place. Copies of the minutes were seen confirming that the manager listens and acts on the views of people living and working in the home. Minutes from staff meetings reflect that these are used as a forum to improve and discus practice to ensure that a good service is provided. The home has a detailed policy on the management of service users money valuables and financial affairs. The home does not manage any of the resident’s financial affairs. All residents manage their own financial affairs or have a relative, guardian of power of attorney to assist them with this process. Residents are provided with information when moving into the home about external advocacy services that can offer support. A system of formal supervision is in place, senior carers are provided with guidance on how to conduct supervisory sessions with staff. Regular supervision is taking place, in line with the recommended six sessions per year, which identifies work and personal issues and future development and training needs. This was confirmed by speaking to staff and from supervision records. The pre inspection questionnaire shows that the home has detailed policies and procedures are in place to protect the health and welfare and safety of the residents and keep records of maintenance within the home. The fire logbook confirmed that regular fire drills, testing of alarms, emergency lighting and visual checks of equipment were taking place. The fire and rescue service completed an audit of the home in August 2006 and recommended that Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 24 intumescent strips to be fitted to fire doors to a number of bedrooms and to fit a self-closure device to the office door. Evidence was seen that these recommendations had been completed. Two areas of concern, which are a potential risk to resident’s health, safety and welfare, were discussed with the manager. There are a number of unguarded radiators around the home. Risk assessments of unguarded radiators and storage heaters must be reviewed on an individual basis to assess the risk of scalding to the residents and remedial action taken as required. Where the fire and rescue service have authorised that it is expectable to wedge frequently used fire doors open, written agreement must be obtained and included in the homes fire risk assessment. Holmwood Residential Home DS0000024420.V326857.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 4 4 4 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 4 4 4 X 4 4 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 3 2 Holmwood Residential Home DS0000024420.V326857.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 OP9 Regulation 13 (2) Requirement Timescale for action 09/01/07 2. OP18 15 3. OP38 13 4 (a)(b)(c) The registered manager must make arrangements for the recording and safe administration of medicines in the care home. Where the behaviour of an 26/02/07 individual has been identified as challenging to others, the registered manager must develop a behavioural support plan which includes agreed strategies for managing this behaviour. The registered manager must 26/02/07 take steps to address two areas of concern, which are a potential risk to resident’s health, safety and welfare. 1. There are a number of unguarded radiators around the home. Risk assessments of unguarded radiators and storage heaters must be reviewed on an individual basis to assess the risk of scalding to the residents and remedial action taken as required. Version 5.2 Holmwood Residential Home DS0000024420.V326857.R01.S.doc Page 27 2. Where the fire and rescue service have authorised that it is acceptable to wedge frequently used fire doors open, written agreement must be obtained and included in the home’s fire risk assessment. A copy of these assessments must be forwarded to the Commission for Social Care Inspection (CSCI). 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 Good Practice Recommendations Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holmwood Residential Home DS0000024420.V326857.R01.S.doc Version 5.2 Page 29 - 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. 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