CARE HOME ADULTS 18-65
Holt Mill House Lloyd Street Whitworth Rochdale Lancashire OL12 8AA Lead Inspector
Mrs Christine Mulcahy Unannounced Inspection 16th January 2006 02:00 Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 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 Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holt Mill House Address Lloyd Street Whitworth Rochdale Lancashire OL12 8AA 0161 7648530 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) woodleighhouse@btconnect.com Mrs Anna Geraldine Ellis Mr Anthony Patrick Copple Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The addition number approved (1) is only valid for name specified service user The service should at all times employ a suitably qualified manager who is registered by CSCI 4th July 2005 Date of last inspection Brief Description of the Service: Holt Mill House is registered with the Commission for Social care Inspection to provide personal care and accommodation to three younger adults who have a learning disability. Holt Mill House is a terraced property that provides facilities and care in a homely environment. It is situated close to the town centre of Whitworth near Rochdale and is within walking distance of local amenities including shops, post office, bus stop and community health services. The ground floor of the home consists of a dining kitchen, utility room, a spacious lounge dining area and a W.C. In addition, there is an office area, which is also used to store medication and records safely. The first floor is accessed by a staircase and provides three large single bedrooms one of which is en suite. Other bedrooms are adjacent to a separate bathroom. Furnishings and decoration is domestic in character. There is an enclosed garden to the rear of the property. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The summary below is an overview of the findings of an unannounced inspection conducted at Holt Mill House on 17th January 2006. The service was inspected against the National Minimum Standards for Adults (18 – 65) At the time of the inspection 8 service users were accommodated at the home. The inspection involved discussion with service users, the registered manager and care staff. Observations were made throughout the visit and records were examined. There are various references to ‘case tracking’ throughout this report. All records relating to these people are inspected, along with the rooms they occupy in the home. Observations are of the care provided, and the service users are invited by the inspector to discuss their experiences of services in the home and what this means for them. The inspection was carried out with the co-operation of the registered manager and service manager. What the service does well:
Through discussions with staff it was apparent service users were in safe hands at all times and staff had the necessary skills to meet their needs. Staff were well trained experienced and were visibly and vocally content carrying out their duties. They were also employed in sufficient numbers to ensure the needs of service users were met. Discussions with staff and service users confirmed that service users were being given the same opportunities regardless of age, and ability and were actively encouraged to use their daily living skills to contribute to the running of the home, like helping in the kitchen or keeping communal or personal spaces tidy. Daily routines in the home promoted independence, individual choice and freedom of movement for both service users. It was evident that service users had the opportunity to maintain and develop social, emotional and communication skills through regular contact with outside agencies, groups, clubs and relatives. This information was well documented in care plans and confirmed by a service user when asked. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
To ensure safe working practices and protect service a number of policies and procedures still require update and review. The service manager has scheduled this work to be completed by July 2006. Case tracking of one service user confirmed there was not a written plan of care. The registered manager had kept diary notes of events and occurrences involving the service user. Although the registered person was able to demonstrate the homes capacity to meet the service user needs through the statement of purpose this was not clearly demonstrated through an agreed individual plan. The registered manager was advised that the plan should be drawn up with the involvement of the service user and appropriate relevant agencies. The plan should also describe the services and facilities to be provided and how these will meet current and changing needs and aspirations and achieve goals. Examination of the homes medicine cabinet highlighted there was a small amount of homely remedies medicines that were not prescribed kept on the premises for service user. The registered manager was required to ensure that Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 7 a record of all current medication including homely remedies received, administered and leaving the home is kept for each service user. Staff rotas were examined and confirmed there were sufficient numbers of staff with appropriate skills to support service users to meet the assessed needs. The rota indicated staffing levels at another scheme house as well as at Holt Mill House and details were unclear. A requirement was made for the staff rota to identify the shifts worked by those employed at Holt Mill House only. 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. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 2, 4 Written information about the home and facilities was comprehensive. Service users always received a case management assessment prior to admissions to the home. EVIDENCE: The care notes of a service user recently admitted to Holt Mill House for respite care was examined and confirmed that the service user had been provided with a service user guide and statement of purpose. Both documents held the required information needed for the service user to make a decision about whether to move into the home The documents also gave the service user information about how the home was run and how the home would meet their needs and aspirations. The service user was admitted to the home in October and diary notes had been kept. Examination of the diary notes confirmed that the service user had spent a number of occasions visiting the home prior to moving in. When asked the service user said that he had been to Holt Mill House to look around before moving in and he was looking forward to staying permanently at the home. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 6, 7, 9 Not all service users had an individual care plan. Staff provided service users with the support needed to make decisions about themselves and the day-today running of the home within a risk managed environment. EVIDENCE: Case tracking of one service user confirmed there was not a written plan of care. The registered manager had kept diary notes of events and occurrences involving the service user. Although the registered person was able to demonstrate the homes capacity to meet the service user needs through the statement of purpose this was not clearly demonstrated through an agreed individual plan. The registered manager was advised that the plan should be drawn up with the involvement of the service user and appropriate relevant agencies. The plan should also describe the services and facilities to be provided and how these will meet current and changing needs and aspirations and achieve goals. The inspector examined the care plan of an existing service user and noted that care plan was drawn up with the involvement of the service user and was generated from a care management assessment and the homes own assessment. It covered all aspects of personal, social and healthcare support
Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 11 and clearly described the strategies staff would use to support the service user to meet the agreed goals. Where potential risks were apparent risk management strategies had been agreed and recorded and reviewed in the individual plan. The care plan highlighted how the service user wanted things to be done in a section called, “Looking after myself.” When asked the service user briefly confirmed that the staff help him to do things in the home and that he attended a day centre where he took part in activities. The inspector observed staff demonstrating a sensitive understanding, and professional approach to the service users and it was apparent they were keen to ensure that the service user maximised control over his life wherever possible. Staff confirmed they were able to encourage service users to make choices about their daily lives and activities. This information was recorded in the service user care plan along with decisions made by staff, relatives and other professionals and why this was the case. The care plan had been reviewed regularly and review information sheets had been completed and signed and agreed by the service user and staff. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 12, 13, 15, 167 Staff helped service users to take part in fulfilling and valued activities through community links and social inclusion. Daily routines promoted independence and freedom of movement for the service users. EVIDENCE: Service users were supported to take part in activities that suited their abilities like social outings and helping with shopping or day centre attendance. Family and friends were welcomed and their involvement in daily routines and activities was encouraged with the service users agreement. One service user said that he had spent Christmas at the family home with his family. When asked he spoke further about attending the day centre where he said he could meet people and do different things. Service users were encouraged to make use of services, facilities and activities in the local community like shops, library, cinema, pubs and leisure centres. Transport was always available and was provided by the homes own people carrier vehicle. Staff confirmed that since the recent discharge of a service user from the home, lifestyle choices were now available to existing service users.
Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 13 One staff said, “We had a trip out to Blackpool a few weeks ago just two staff and two service users. The service users had a good time even though the shops were closed, we had a walk around, took in the fresh air had a chippy dinner and then went home”. Staff confirmed that one service user had recently become involved in domestic tasks in the kitchen and visits from family had increased. Where appropriate, service users were supported by staff to maintain family links. Friendships inside and out of the home were encouraged with the service users agreement. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 20 The control of prescribed medication was managed to promote good service user health. EVIDENCE: There was a medication policy and procedure at the home. Written guidance was available for staff to follow when administering medication. Policies and procedures examined ensured service user safety. All medicines were stored in a locked cupboard within a secure room that could be accessed only by staff. Medication records were signed by staff and had been kept up to date. The inspector noted that a small amount of homely remedies that were not prescribed were kept on the premises for service user. The registered manager was required to ensure that a record of all current medication received, administered and leaving the home is kept for each service user. Discussions with staff confirmed they had received up to date training in the safe handling of medicines and through this was able to demonstrate their competencies in this area of service user care. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 22, 23 The homes clear and effective complaints procedure included the stages and timescales for the process. EVIDENCE: Service users at Holt Mill House had been given a copy of the homes complaints procedure along with the service user guide. When asked the registered manager and staff confirmed they would listened to and act on the views and concerns of service users and others. The registered manager said, “We always listen to service users and try to sort things out before they become bigger problems, but we haven’t had many complaints here recently.” The inspector examined the homes record of complaints and noted that no complaints had been made since the last inspection There was a robust procedure for responding to suspicions or evidence of abuse or neglect (including whistle-blowing) that ensured the safety and protection of service users. When asked one staff said that he had received abuse training and said that sometimes service users displayed challenging behaviour, physical and verbal aggression but he felt competent enough to deal with this appropriately following strict guidelines and ensuring information was recorded after any incident of prevention. Risk assessments were available and were examined along with a care plan to ensure that service users were protected from harm at all times including during the use of control and restraint. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 16 The homes policies and procedures regarding service users money and financial affairs ensured safe storage of money and valuables within the home. Service users were encouraged to have separate savings accounts or relatives took responsibility for this. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed at this inspection and there had been no changes since the last inspection EVIDENCE: Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 33, 34, 35 Robust recruitment policies and procedures were in place to protect service users. Ongoing training ensured up to date information for staff. Staff were trained well enough to ensure the needs of service users were met. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 19 EVIDENCE: The inspector spoke to two members of staff who both worked at Holt Mill House and another home within the scheme. Robust recruitment procedures ensured service users were protected. Staff confirmed that training and development opportunities were frequently available and they had received training in Health and safety, first aid, NVQ 2, medication training, and fire training. They said they were happy to work within the Holt Mill environment, one staff said, “What’s good about the scheme is the service users, the staff and the job is very rewarding.” The staff rota was examined and it was clear that the ratios of staff to service users was determined by service user needs. There was a core team of existing staff who worked at Healy house and another house that was part of the scheme. The inspector noted that the staff rota did not clearly indicate the status of the staff on duty. The rota was also used to indicate the hours worked at the other scheme house. The registered manager was required to ensure that the staff rota indicated the work times and roles for staff who worked at Healey House only and not other establishments within the scheme. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 37, 39, 41, 42 The management and staff provide a safe and well-run environment for service users to live in. Policies and procedures at the home safeguarded service users rights and best interests. Staff records were kept in the home. EVIDENCE: The registered manager has 10 years experience of working with adults with a learning disability and has numerous work related qualifications. She has a BA in “Professional Studies Learning Disabilities”, and should complete the Registered Managers Award (RMA) in July 2006. She was actively involved in the Investors In People quality award, used to review and internally audit the service on an annual basis. The health safety and wellbeing of staff and service users were promoted through the homes policies and procedures. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 21 A review of the homes policies and procedures had begun and would take place in their priority order. The newly revised policies and procedures on adult protection and abuse met all elements of the national minimum standard. All employees had signed to confirm their understanding of both documents. Staff meetings and supervision were said to be in place. Records of staff employed at Holt Mill House were kept in a secure office within the adjacent day centre. These should be stored in a secure place in the home. The Commission recognise this might be impracticable to do so but would require access to the records at anytime of the day or night. The registered manager was required to ensure that staff records of employees who work at Holt Mill House and Healey House are securely stored with other staff records at Healey House. Staffing levels were always increased at busier times of the day for example mornings, evenings, and weekends. There had been some progress towards updating systems to ensure the health, safety, and welfare of service users was being protected. Staff had received training in moving and handling, fire safety, first aid, food hygiene, and the safe handling of medicines. Systems were in place to ensure challenging situations involving service users were risk assessed to ensure staff and service users were safe from harm. A planned maintenance programme included details of maintenance work required around the home. The inspector was satisfied the registered manager ensured compliance with other relevant health and safety legislation through robust policies, procedures and practices. Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Holt Mill House Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 3 3 X DS0000039980.V273102.R01.S.doc Version 5.0 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation Schedule 4(6) Requirement Timescale for action 17/01/06 2. YA24 Regulation 23 3 YA6 Reg 15(1)Sch 3(1)(b) 4 YA20 Regulation 13(2) The registered manager was required to ensure that for the protection of the service users and efficient running of the home, the records of employees who work at Holt Mill House and Healey House are securely stored with other staff records at Healey House. The registered manager must 17/05/06 ensure that the premises are kept in a good state of repair externally and internally by ensuring that the outstanding repairs identified at the last inspection are completed as stated on the homes record of planned maintenance. The registered manager must 20/01/06 ensure that the service user admitted in October 2005 receives a written care plan as described in the body of the report and that meets the requirements of Regulation 15(1) The registered manager must 20/01/06 ensure that records of all homely remedies are kept in the home to ensure good service user health and welfare.
Version 5.0 Holt Mill House DS0000039980.V273102.R01.S.doc Page 24 5 YA33 Schedule 4(7) The registered manager must ensure that a separate copy of the duty rota is kept for Holt Mill House this should include people working in the home and confirm whether the rota is actually worked. 17/01/06 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 Holt Mill House DS0000039980.V273102.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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