Inspection on 02/06/08 for Holmwood Residential Home for Older People

This inspection was carried out on 2nd June 2008.

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

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

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Holmwood Residential Home for Older People 30 Fowlers Road Salisbury Wiltshire SP1 2QU Lead Inspector Malcolm Kippax Unannounced Inspection 2nd June 2008 09:30 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 for Older People DS0000070603.V361942.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 for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood Residential Home for Older People Address 30 Fowlers Road Salisbury Wiltshire SP1 2QU 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) 01722 331130 01722 322733 Wessex Care Ltd Mrs Pauline Margaret Airey Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 18. Date of last inspection Brief Description of the Service: Holmwood Residential Home has been operating as a care home for a number of years. The home has been owned and managed by Wessex Care Ltd since November 2007. Wessex Care Ltd. runs three other care homes in the Salisbury area. These homes are for people who are in need of nursing care, or who have dementia. Holmwood Residential Home provides care and accommodation to older people who do not have such specialist needs. The home is in a residential area of Salisbury. The residents’ accommodation is on the ground and first floors, with a passenger lift available. The communal rooms include a lounge and a dining room on the ground floor. These rooms overlook a garden at the rear of the property. There is a management team that includes the registered manager, a care manager and a deputy manager. There is a permanent staff team of carers and ancillary staff. Some of the administrative work is undertaken at offices in one of Wessex Care Ltd.’s other homes. The range of fees at the time of this inspection was between £430 and £550 per week. Further information about the home is available in a ‘Statement of Purpose’. Inspection reports can be seen in the home and are also available through the Commission’s website: www.csci.org.uk Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the first inspection of Holmwood Residential Home since being owned by Wessex Care Ltd. We already knew how Wessex Care Ltd intended to run the home, from the information that they gave us when they applied to be registered. After Wessex Care Ltd had been running the home for a few months, we asked them to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how well they were performing and it gave us information about their future plans. We also sent out surveys to the residents, their relatives, to staff and to health care professionals, so that we could get their views about the home. Ten residents, three relatives, three staff and a GP returned surveys to us. We reviewed the information that we had received about the home since November 2007, when Wessex Care Ltd was registered to run the home. We made an unannounced visit on 2nd June 2008 and met the residents and some of the staff. We looked around the home and saw a number of records. We also talked to Mrs P. Airey, the home’s registered manager, and to Mr M. Airey, who is in the role of ‘Responsible Individual’ for Wessex Care Ltd. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. The assessments provide good information about a new resident’s care needs. A ‘Preliminary Care Plan’ is completed within 24 hours of a person’s move into the home. This looks like a good way of ensuring that staff have the initial information that they need to provide people with the right support. People’s main care plans cover different areas of need and generally provide good guidance for staff. Particular matters such as the need to promote fluid intake are highlighted, so that they are brought to the carers’ attention. People feel that they are being well cared for and treated with respect. We spoke to residents who said that they were well supported with their Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 6 healthcare. One person said that they were particularly pleased with the support that they received when in hospital recently. People can choose where to have their meals. Most people said that they usually liked the food. They can keep in touch with their families and can participate in the different activities that the home arranges. These include some ‘one-off’ events, such as when two birds of prey were brought to the home as part of one of the afternoon entertainment sessions. People said that this had been a very popular event and they were looking forward to a return visit. People are aware of how to make a complaint. Staff members receive guidance and training that helps to protect people from being harmed. People have personalised their own accommodation, and they will benefit from the improvements that are being made. When we visited, the home looked clean and there were no unpleasant odours. People told us that the home is always kept fresh and clean. People’s needs are being met by competent staff who are developing their skills and knowledge. The residents we met during the visit spoke positively about their dealings with staff. One person described staff as ‘friendly and helpful’, and another person said ‘they keep an eye on us’. Residents had staff call alarm points in their rooms. The people we met said that they did not need to use these very often, but had been reminded by staff that they were there, and should be used when needed. People live in a home that is run by an experienced manager. Systems are being set up, which help to ensure that the home is run in the residents’ best interests. There is a quality assurance system being operated, which shows that the service is able to look at its own performance and decide on how it needs to develop in order to improve further. What has improved since the last inspection? What they could do better: There was information in the AQAA about what the home does well and the improvements that have made since Wessex Care Ltd. took over. We were also given a lot of information about what the company feels can be done better in the home, and its plans for the future. These are being implemented over time, so that residents will benefit from further improvements in the service that they receive. We highlighted particular matters that need attention, or we think would Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 7 enhance the service that residents receive. Requirements have been made in respect of medication, to ensure that the storage arrangements meet current standards, and the records are appropriately completed at all times. We have also recommended that the medication arrangements are reviewed, with the aim of ensuring that these are fully consistent with professional guidance, and that staff are consistent in their approach. This is so that residents can be confident that their medication is always being managed safely on their behalf. Another requirement concerns the need to apply a robust and thorough recruitment process at all times. This is so that the process is fully consistent with the home’s policies, as well as with the guidance that has been produced about the protection of vulnerable adults. We have recommended that the care planning system is developed, through the greater involvement of residents, and by having a specific care plan for use when residents have short-term or temporary needs. This is so that the care plans reflect the residents’ own views and provide more details about their individual needs. Another recommendation has been made about obtaining the residents’ views about the choices that they are given on a daily basis. This is so that the home can be confident that the arrangements in place are meeting the residents’ individual needs and preferences. We found that individual fire risk assessments by the front door were not fully up to date. We have recommended that these are frequently checked, to ensure that the contents are accurate at all times. 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 for Older People DS0000070603.V361942.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 Holmwood Residential Home for Older People DS0000070603.V361942.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People’s needs are assessed before they move in, so that a decision can be made about whether the home will be suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were told in the AQAA about the home’s admission procedure and how information was obtained about prospective residents. This included discussions with the person, and with their relatives where appropriate. The home carried out its own assessment of people’s needs and sought to obtain other information that would be relevant to the assessment. There was then a discussion with the person, and their relative or advocate, about the outcome of the assessment and whether the home could meet the their identified needs. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 10 During our visit we spoke to somebody who had recently moved into the home. They said that that they had talked about their needs before moving in. We saw records in the home, which showed how the assessment process was being documented. Forms had been produced for recording the different stages of the process. The initial contact with a prospective resident was recorded on an enquiries form. There was a pre-admission assessment form, which included sections for recording people’s needs, in areas such as mobility, diet, continence, communication, moving and handling, and personal hygiene. We saw examples of assessment forms that had been completed with the appropriate information. Mrs Airey said that she carried out the assessments. There was also an admissions form, for recording people’s personal details when they moved into the home. We saw other information on people’s personal files that had been obtained prior to admission. This included, for example a copy of a community care assessment. Other information was being obtained and recorded after the move, as staff got to know the person better. This gave more details about people’s personal circumstances and diverse needs. The home told us in the AQAA that they intended to develop the assessment and admissions procedure by introducing an admission checklist and recording information pertaining to the Mental Capacity Act. Holmwood Residential Home for Older People DS0000070603.V361942.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good overall. People’s health care needs are met. People feel that they are well cared for and treated with respect by staff. There are developments relating to care planning and medication, which will further improve the home’s systems and enhance the support that people receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People had personal files, which were kept in the home’s office. We looked at three people’s files, which contained their assessment records and care plans. The records included a ‘Preliminary Care Plan’, which Mrs Airey said was completed within 24 hours of a person’s move into the home. This looked like a good way of ensuring that staff had the initial information that they needed to provide people with the right support. We asked staff members in their surveys if they were given up to date information about the needs of the people they supported or cared for (for Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 12 example, in the care plans). The three staff members responded ‘always’. One person commented ‘we are always given a handover before the start of each shift’. People’s main care plans consisted of a number of forms. These covered different areas of need, including Personal Hygiene and Grooming, Continence Care, Nutrition, Sleep and Rest, Mobility and Pressure Care, and Social and Emotional needs. There forms had sections for recording the intervention that was needed from staff, the level of assistance required, and any relevant history. Information was also recorded under the heading of ‘Suggested approaches’. This was used for highlighting particular matters, for example the need to ‘Promote fluid intake’, so that they were brought to the carers’ attention. There was a ‘Care Review Record’ form, where details of changes in the care plan were being reported. The forms were being reviewed at least monthly, and dated to show when this had happened. Overall, the care plans looked informative, although they had not been signed by residents, or their representative, and did not directly reflect people’s own views. Assessments had been undertaken in relation to specific areas of need, in order to provide further guidance for staff or identify people who might be at risk. We saw that assessment forms had been completed for moving and handling, falls, self-medication, and pressure care. The residents we met during our visit said that they received support with making their health appointments. One person mentioned that they had been well supported when they visited a hospital recently. People also said that the staff treated them well and respected their privacy. Written guidance and codes of conduct were provided to staff, which referred to the rights of residents, and the values and principles which should be applied when providing care. A GP who completed a survey responded positively about the care and support that people received in the home. Details of people’s contact with health professionals were being recorded, and ‘Record of Visits’ forms were being used. These showed that people were seeing chiropodists, dentists and their GPs. The pressure care assessments that we saw for two people referred to the involvement of the district nurse. The nurses’ records were readily available to staff. They contained information about people’s treatments and how the carers should be involved. Some of the nurses’ visits and observations had been reported on the ‘Record of Visits’ forms, but this was not being consistently done. Since visiting, we have received further information from the home about how the nurses’ visits are reported in other records, such as a Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 13 ‘care kardex’, to ensure that staff are aware of people’s current care needs. The home did not use a care plan that was specifically for short-term, or temporary needs, such as conditions that are being treated by the nurse. We thought that this could be a useful addition to the care planning system and be one way of highlighting any matters that the carers needed to be aware of. Records of care were being maintained. These generally looked informative, although there was some variation in how tasks were recorded. For example, some entries detailed the care that had been provided, and others included the comment ‘All assistance given as needed’. People’s care records included a list of their prescribed medication. There was information for staff, so that they would know what the medication was for. Some of the records were not dated, although this would show that they are current and help to ensure that the information is always up to date. It was reported in the AQAA that GPs are requested to visit people within 24 hours of admission in order to review medication and their general health. We were also given information in the AQAA about the home’s procedures for managing people’s medication. It was reported that no issues were identified at the last pharmacy inspection. Training was provided to staff, who only administered medication after being deemed competent by the manager. We met a staff member during our visit who said that they had received training and that this was given to staff before they could administer any medication. We looked at the storage arrangements for medication. When Wessex Care Ltd took over the home the medication facilities were not up to the current standard. We discussed this with Mrs Airey and Mr Airey, who confirmed that they will be taking action to meet the regulations that now apply to care homes in respect of the storage of controlled drugs. The home used a monitored dosage system (M.D.S.) for the administration of medication. Stocks of controlled drugs were being recorded in a controlled drug register book. We saw that some medication had been removed from the M.D.S. blister packs out of sequence, although we checked examples of the medication stocks and found that the records of these were up to date. We looked at the some of the medication administration records. The records were up to date. Overall, the records were being appropriately maintained, although we saw occasions when the medication procedure had not been followed in full. These included the code not being used when medication was refused, and times when a second staff member had not signed the record in the case of controlled medication. We later discussed our findings with Mrs Airey and Mr Airey. They gave us a full response to the matters raised and confirmed the action that would be taken to ensure that all staff complied with the procedure for administration. Holmwood Residential Home for Older People DS0000070603.V361942.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. People have daily routines and participate in activities which generally reflect their needs and individual preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We met residents during the morning of our visit, mostly in their own rooms. People had their own possessions around them and there were a lot of pictures and family photographs, which gave the rooms a very individual appearance. People were watching television, reading, or just relaxing. Some people spent time with their relatives and there was a visitors book in the hall that people had signed. A number of people also had appointments with a hairdresser who was visiting the home at the time. Information was recorded in people’s personal files about their family contacts and relationships. This helped staff to know who would be likely to visit and which residents may not have company regularly. People told us that they generally liked the meals. Somebody said that they liked the tea meal, when they could choose from different dishes. One person Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 15 said there was no choice at lunchtime ‘unless you requested it’. Another person thought the meals were good but they did not usually know what was on the menu, unless they had heard it ‘on the grapevine’. There was a menu board displayed in the dining room. Somebody mentioned that staff knew about their particular likes and dislikes. In their surveys, two people said that they always liked the meals; seven people responded ‘usually’, and one person said ‘sometimes’. Mrs Airey and Mr Airey confirmed that the home was able to provide an alternative meal at lunchtime. They told us that they are considering introducing a weekly menu sheet for each resident for ease of reference. At lunchtime, some people chose to eat in their rooms and staff brought their meals on trays. Other people had lunch in the dining room. Their meals looked freshly cooked and the portions had been adjusted to suit what people wanted. Records were kept of the meals prepared. A number of residents spent time in the communal rooms after having lunch. Somebody had arranged to visit another resident in their room. Someone else told us that they regularly went out with a friend for a walk locally. They said that they told staff what they were doing, so that they would not be missed. We talked to some people about the day to day routines. They could choose where to spend their time and could mix with other people when they wanted to. Two people mentioned that they had been given a set ‘bath day’ and time and one person said that they would prefer this to be at another time. We asked people in their surveys whether there were activities arranged by the home that they could take part in. Five people responded that there always were, three people responded ‘usually’, one person ‘sometimes’ and another person ‘never’. Mrs Airey reported in the AQAA that one of the improvements that they had made since taking over the home was to employ a person to co-ordinate and provide activities for people in the home. They had also identified the need to ensure that the activities encompassed the needs of all the residents and were not solely female orientated. Information was displayed in the dining room about different activities that were taking place in the home. These included some ‘one-off’ entertainments, and other events that took place regularly as part of the home’s activities programme. There were photographs displayed of two birds of prey that had been brought to the home as part of one of the afternoon entertainment sessions. People we spoke to said that this had been a very popular event and they were looking forward to a return visit. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 16 People’s religious needs were identified as part of the pre-admission process. We received information in the AQAA about diversity and people’s individual cultural and spiritual needs. Mrs Airey reported in the AQAA that the home provided opportunities for people to worship in the chosen faith by inviting religious leaders into the home, or by arranging escort and transport to services outside the home. In their surveys, we asked relatives whether the home met people’s different needs, for example in respect of their race and ethnicity, age, disability, gender, faith and sexual orientation. Two relatives responded ‘always’, and one person ‘sometimes’. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People know how to make a complaint and there are procedures in place, which help to ensure that they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nine residents confirmed in their surveys that they knew how to make a complaint. The three relatives also confirmed that they knew about this. We saw that a copy of the home’s complaints procedure was displayed by the visitors book in the front hall. The procedure included the Commission for Social Care Inspection, although some details for contacting the Commission needed to be updated. There was a complaints log, which Mrs Airey reported was audited monthly. All the complaints that the home received were reported to have been resolved within 28 days. We asked relatives in their surveys whether the home had responded appropriately to any concerns that had been raised about people’s care. One relative responded ‘always’, and the others responded ‘usually’ and ‘sometimes’. Mrs Airey reported in the AQAA that the home had policies about safeguarding adults and reporting abuse, restraint (including the use of bedrails), and Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 18 whistleblowing. There was annual training for staff about the protection of vulnerable adults. Staff members told us in their surveys that they knew what to do if somebody had concerns about the home. We spoke to staff members, who confirmed that they had received training in abuse awareness and how to follow up any concerns that were raised with them. Staff said that this was covered in induction and that they had watched a video about abuse during the previous month. We saw that there was a copy of the ‘No Secrets’ booklet in the home’s office. This provided information about different types of abuse and the procedures to be followed in Wiltshire and Swindon if there is a concern about abuse. We looked at the records for one person who had moved to the home from outside Wiltshire. Their file contained a copy of another local authority’s procedures for safeguarding vulnerable adults. This would ensure that staff also had the necessary information should a concern arise which needed to be followed up. The home has had experience of implementing Wiltshire and Swindon’s procedures for safeguarding vulnerable adults. This showed that they are aware of the role of other agencies in ensuring that any allegations are appropriately followed up. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. People have accommodation that meets their needs and they will benefit from the improvements that are being made. The home is kept clean and there are no unpleasant odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Holmwood is in a quiet residential area, but close to some of the city’s main through roads. Residents had their accommodation on the ground and first floors. The communal rooms included a lounge and a dining room on the ground floor. These rooms overlooked a garden at the rear of the property. People said that they enjoyed the gardens and liked the views that it gave from their own rooms. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 20 We saw residents using the communal rooms for specific activities. The rooms were light and located within the main area of the home. Residents were also choosing to spend time in their own rooms, which had different outlooks. People looked ‘at home’ in their rooms and had their own possessions around them. Doors had been fitted with automatic self-closing devices, so that they could safely be left open, if this is what the residents wanted. It also meant that if the door was closed, it could be opened without undue force and more easily than doors that are fitted with a basic type of self-closure. We were told in the AQAA about the various measures that were in place to ensure that a safe environment was being maintained for the residents and staff. These included the protection of radiators, temperature control of the hot water, infection control procedures, risk assessments and external inspections. We met a maintenance person who was following up on a list of jobs, including those that had been reported in a maintenance book kept in the hall. It appeared that the jobs were being responded to promptly. The accommodation that we saw looked clean and there were no unpleasant odours. People told us that they were satisfied with the support that they received with the cleaning of their own rooms. Nine people who completed surveys said that the home was always fresh and clean. One person felt that this was usually the case. Holmwood was well established as a care home when Wessex Care Ltd became the owners in November 2007. We were given a lot of information in the AQAA about the company’s plans for developing the facilities and for enhancing the home environment. Some work had already taken place, including changes to the home’s cleaning and laundry arrangements. New machines have been bought for the laundry, and some new procedures introduced, such as the provision of alcohol hand gel to help prevent cross-infection. On the day we visited, a plumber was in the home fitting some new wash hand basins in people’s rooms. These were of a different design, so that people would find them easier to use. There were plans to develop the lower ground floor of the home, to provide further communal space and to make it easier for people to access the rear garden. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate overall. People’s needs are being met by competent staff who are developing their skills and knowledge. The home’s recruitment practice is normally robust and protects people, however there has been an exception to this on one occasion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We met with the home’s deputy manager at the start of our visit and she told us how staff are deployed during the day. There was a minimum of two care staff deployed throughout the day, with a third person working between 8.00 am and 2.00 pm. Ancillary staff were employed to cover cooking and the cleaning tasks. Two staff on waking duty worked at night. Staff rotas were kept to show who was working. We were told about changes that had been in the staffing arrangements since Wessex Care Ltd. took over the home. These included an increase in cooking hours and added time for social activities. In their surveys, we asked residents whether staff were available when they needed them. Four people responded that they always were, five people responded ‘usually’ and one person ‘sometimes’. We also asked ‘Do the staff Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 22 listen and act on what you say’? Eight residents responded ‘yes’ and one person responded ‘no’, but did not elaborate on this. The residents we met during the visit spoke positively about their dealings with staff. One person described staff as ‘friendly and helpful’, and another person said ‘they keep an eye on us’. Residents had staff call alarm points in their rooms. The people we met said that they did not need to use these very often, but had been reminded by staff that they were there, and should be used when needed. Staff members were asked in their surveys whether there were enough staff to meet the individual needs of all the people who used the service. One staff member responded ‘always’ and two staff members responded ‘usually’. Two relatives told us in their surveys that they thought that staff always had the right skills and experience to look after people properly. One relative responded ‘usually’ to this question. We were provided with information about staffing in the AQAA. Over 50 of the care staff team had achieved a National Vocational Qualification (NVQ) in Care at Level 2 or above. NVQ training was being accessed for those staff who did not have English as their first language. We asked staff in their surveys whether their induction covered everything they needed to know to do the job when they started. They told us that it had covered things very well. Two staff members also told us that they were being given training which was relevant to their role, helped them understand and meet the residents’ individual needs, and kept them up to date with new ways of working. The third staff member who returned a survey did not respond to this question about training. We were told in the AQAA about the plans being made for staff induction and training. There were plans to introduce a ‘Skills for Care’ induction. This will ensure that the home’s induction programme meets the standard that is expected for people working in the care sector. During the visit we were shown training plans for the year, which covered internal training events and external courses. These showed that training was being arranged in subjects that were relevant to the care and safety of residents. Some areas of training were mandatory for staff to attend, and others were voluntary. New training records had been set up for staff members. Mrs Airey reported that staff members’ individual training needs were being identified through supervision. During our visit we met staff who had recently attended training in moving and handling, and in medication. One staff member commented that there are ‘always courses available’. We saw information about staff training events displayed in the home. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 23 We asked staff in their surveys whether their employer had carried out checks, such as your CRB and references, before they had started work. They confirmed that they had. We met the Administrator who had responsibility for dealing with recruitment procedures for Wessex Care Ltd and the associated paperwork. The main personnel files were kept at Wessex Care Ltd’s offices in one of their other homes. The Administrator explained the recruitment process and confirmed the checks that were being undertaken. A business services consultancy company was being used to advise on personnel and employment matters. We looked at examples of the recruitment records. Prospective staff members completed an application form, which included a self-declaration in respect of the applicant’s health. Written references and proof of identity were being obtained. Criminal Records Bureau (CRB) disclosures and checks of the Protection Vulnerable Adults (POVA) list were being arranged through an umbrella organisation. The system of ‘POVA first’ was being used, to enable staff to start working in the home, under supervision, before their CRB disclosure came through. Staff members normally completed a period of orientation after their name had been checked against the POVA list and before they started to work directly with the residents. We talked to the Administrator about the recruitment of one carer, who had been offered employment and started a period of orientation before the outcome of the POVA list check was known. Mrs Airey and Mr Airey later provided us with information about the staffing difficulties that prevailed at the time, their assessment of the situation, and how this person spent their time during their period of orientation. Mrs Airey and Mr Airey reported that it was an exceptional situation, which had necessitated a deviation from the usual recruitment procedure. They said that there was a need to ensure that the staff member would be available to work as soon as their POVA check clearance had been received. We were told that the staff member’s POVA check was obtained and they remained in a supervised capacity until their CRB clearance was received. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. People live in a home that is run by an experienced manager. Systems have been set up which help to ensure that the home is well managed and runs in peoples’ best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs P. Airey was registered as manager when Wessex Care Ltd. became the owners of Holmwood in November 2007. As part of the registration process, the applicant is required to have shown that they are a ‘fit person’ to manage the home. ‘Fitness’ refers to a number of personal attributes, such as having integrity and being of good character. The applicant will also have Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 25 demonstrated that they have the qualifications, skills and experience that are necessary for managing the care home. Mrs Airey received support in the managing the home from a ‘floor’ manager and a deputy manager. Mrs Airey and Mr Airey described the position of floor manager as a ‘Care Manager in training’. The floor manager had some delegated responsibilities and was developing their management role under Mrs Airey’s supervision. The AQAA that we received included detailed and comprehensive information about the home’s strengths, the plans for the next 12 months and how it was intended to develop the service that residents receive. This showed that the home was able to identify ways in which improvements could be made. Many of the improvements and developments referred to in the AQAA were also included in the home’s internal Improvement Plan for the year. This had been produced following an audit of standards that had been undertaken as part of the home’s system for quality assurance. Mrs Airey and Mr Airey said that they were now looking to formalise the way in which they received feedback from residents and other parties. Some internal questionnaires had already been used after Wessex Care Ltd. took over the home, in order to get people’s views and hear about their priorities. A management action plan was being implemented to address the improvements and developments that were planned. There was a procedure for dealing with residents’ finances. Financial affairs were managed from Wessex Care Ltd’s main office, from where statements of account were issued to the residents or their representatives. We were told that money kept in the home was limited to small amounts of cash, which was audited and checked each month. There were lockable facilities available for the storage of residents’ valuables. Guidance was available to staff about good practice in respect of their involvement with residents’ financial affairs. We were given information in the AQAA about the arrangements being made for health and safety. Policies and procedures had been produced for specific areas, such as the control of substances hazardous to health (COSHH), fire safety and infection control. We saw certificates for the electrical wiring system and for gas safety. A health and safety check was being carried out in the home regularly and a checklist completed. We were told that a fire safety consultant advised on all matters relating to the home’s fire precautions, and provided training to staff on a regular basis. Tests of the fire precaution systems were being recorded and these had last been undertaken in May 2008. A fire drill was last carried out in March 2008. We saw risk assessment records in the home including one for fire, which was dated 30th January 2008. There were also individual fire risk assessment records that were kept by the front door. These gave useful advice about the Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 26 residents’ individual circumstances, in the event of a fire. However, we saw that the records included an assessment for one person who was no longer in the home, so they could not be relied upon to give accurate information about who was in the building. We brought this to the attention of Mrs Airey, who then removed the assessment. Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 27 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 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 28 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 All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). The administration of medication records must be appropriately completed at all times. A robust and thorough recruitment process must be applied at all times, so that it is consistent with the home’s policies and the guidance that has been produced concerning the protection of vulnerable adults. Timescale for action 30/09/08 2. OP9 13(2) 03/06/08 3. OP29 19 03/06/08 Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 29 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 That residents are invited to contribute more directly to the completion of their care plans, for example by signing the plans to confirm their agreement, and by the inclusion of a section in the plans which reflects their own views. That a form of care plan is produced that is specifically for use in connection with short-term or temporary needs, such as conditions that are being treated by the district nurse. This would be a way of highlighting for the carers any matters that they should be aware of and the tasks that they are expected to undertake. 3. OP9 That a review is undertaken of the current arrangements in place for the safekeeping and administration of the residents’ medication. This is with the aim of ensuring that the arrangements are fully consistent with professional guidance and that staff are consistent in their approach. 4. OP14 That the residents’ views are obtained about how well the home is providing choice on a daily basis, for example at meal times, and about when people are able to receive support with having a bath. This is so the home can be confident that the arrangements in place are meeting the residents’ individual needs and preferences. 5. OP38 That the individual fire risk assessments by the front door are frequently checked to ensure that the contents are accurate and up to date. They could, for example be included in the home’s health and safety checklist. 2. OP7 Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holmwood Residential Home for Older People DS0000070603.V361942.R01.S.doc Version 5.2 Page 31 - 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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