CARE HOMES FOR OLDER PEOPLE
The Holt Main Street Hutton Buscel Scarborough YO13 9LN Lead Inspector
David Blackburn Unannounced 04 May 2005 09:00 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 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. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Holt Address Main Street, Hutton Buscel, Scarborough, North Yorkshire YO13 9LN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01723 862045 victoria.towse@btopenworld.com Miss Victoria Towse, Mr Herbert Towse and Mrs Carol Towse. Miss Victoria Towse Care Home Only 22 Category(ies) of Dementia over 65 [DE(E)] registration, with number of places The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 15/02/05 Brief Description of the Service: The Holt is a large imposing building set in its own secure, secluded and well kept grounds. A former vicarage, it was converted some years ago into a residential care home for 22 people admitted through old age or infirmity. All suffer from some form of dementia. The buildings location makes it convenient for local amenities and facilities in the village. Public transport to neighbouring towns and villages passes the door. The home is on three floors. A passenger lift gives access to all floors used by residents. The ground floor has the comunal areas, some bedrooms and the kitchen. The first floor has further bedroom accommodation. The top floor is for staff use only. There are 16 bedrooms for single occupancy and 3 bedrooms for shared occupancy. 10 of the single bedrooms have an ensuite facility. There are sufficient communal bathrooms and toilets. The staff provide personal care, including washing, dressing, toileting and bathing, a catering service, a laundry service and domestic and cleaning services. Staff cover is provided throughout any 24 hour period. Some activities are offered in the home. All service users are registered with a local medical practice who addresses their primary health care needs. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection upon which this report is based was the first to be undertaken in the inspection year April 2005 to March 2006. It was carried out over six hours including preparation time. The focus was on a number of the key standards together with those that were the subject of requirements or recommendations at the last inspection. An inspection of some parts of the premises together with a number of bedrooms was also carried out. A number of documents including some policies and procedures were examined. Discussions were held with the registered manager and staff on duty including care assistants, catering staff and domestics. Six service users were spoken with though the ability of some to communicate meaningfully was limited by the onset of dementia. A number were however able to make comments about different aspects of the care, services and facilities on offer. Conversations were also held with three visitors. What the service does well:
The registered owners provided a good guide to the home that gave any one seeking admission information on the service provided. Good assessment methods were in place that ensured those admitted would have their personal and health care needs fully understood and met. A visitor said “I feel my mother’s needs were well assessed. They seem to know what she needs and when.” Personal and health care needs of residents including medication were generally well recorded and acted upon by staff promoting good health. Visitors commented “They’re very well looked after and there’s no qualification needed.” The service users were happy with the food being provided. Proper attention was given to any special dietary needs. Service users and visitors made positive comments about the overall catering services. “The food is always well presented. Mum never has any complaints.” The building was well looked after being warm, clean and free from offensive odours. A visitor stated “I call at various times and on various days. I always find it clean, warm and without any smells.” Overall proper attention was given to health and safety so that those living there were safe and secure. The number of staff employed by day and by night gave service users the confidence that their needs could and would be met. Service users and visitors were complimentary in their comments about staff. “They’re very good to me.” “Staff are very good with mum. They seem to understand and anticipate
The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 6 her needs. She couldn’t be in better hands.” A number of staff had achieved a National Vocational Qualification in care. What has improved since the last inspection? What they could do better:
While a good pre-admission assessment form was in use, this should be signed and dated by the person undertaking the assessment. On-going assessments of needs including nutritional screening must be kept under review. The care plans must be revised as necessary to ensure all aspects of any service users’ care is recorded and acted upon. Service users or their representatives should be encouraged to sign their care plans to get their approval for the services to be provided in the home. The medication record sheets must be initialled at the time medicines are administered to ensure all staff are aware they have been given and to eliminate any risks to services users. Reasons for non-administration must be noted on the record sheets. The complaints procedure must show the name of the new regulatory authority and the right of any complainant to approach that authority at any time. All opening windows must operate in a safe and proper manner. The owners should continue to encourage their care staff to undertake and achieve a National Vocational Qualification (NVQ) in care to level 2 and any registered manager to level 4 in care and management. The questionnaires devised to seek views on the care, services and facilities provided in the home should be distributed to service users and visitors as soon as possible. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 7 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 Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 6. Information published by the home together with a detailed pre-admission assessment procedure was very good providing users and prospective service users with a clear indication of the care, services and facilities on offer in the home and assuring them that their needs would be met. EVIDENCE: The Statement of Purpose and Service User Guide met current requirements. Both documents were clear, precise, informative and detailed in their content. Pre-admission assessment forms were seen on each service user’s file examined. Staff at the home had undertaken the assessment and completed the form for those privately funded. For publicly funded service users the assessment had been carried out by a care manager from the placing authority. The information gained provided the basis for care needs to be identified and care plans developed. All gave a good indication of the care needs of the prospective service user. It was recommended that they be signed and dated. The registered manager stated they offered no form of intermediate care. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9. The physical and health care needs of residents were well recorded and acted upon by staff promoting good health. Minor discrepancies in the medication recording had the potential to place service users at risk. EVIDENCE: The case files examined contained a copy of the care plan. This was either devised in the home or provided by a care manager of the placing authority. Copies were seen in bedrooms. None had been signed. Care plans were being reviewed monthly and recorded. Continuation sheets for each service user recorded significant day-to-day events. The care plans recorded the personal and health care needs of service users. The continuation sheets showed how care was being delivered on a daily basis. Pressure area care, tissue viability and continence promotion were recorded as necessary. The involvement of specialist health workers in these matters was detailed in the case files. Risk assessments were available in each file seen. Nutritional screening was undertaken as required. However for one service user their needs in this area had not been fully recorded. Service users were complimentary about the care being given. “They’re very good to me. They seem to know what I need.” Visitors made similar comments. “My mother has
The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 11 improved quite dramatically both physically and mentally since her admission.” “ Staff give Mum the attention she needs and I feel she responds positively to that.” Proper procedures were in place for the ordering, receipt, storage, administration, and return of medication. The correct procedures were being followed. However on scrutiny of the medication administration sheets it was noted that there were gaps in a small number of recordings for the previous day. A reconciliation of the actual medication against the records showed medicines not given out but initialled as such on the record sheets. Recording must be carried out at the time medication is administered to eliminate any risks to service users. The registered manager agreed to make an immediate check and to re-emphasis to staff the need to be vigilant when dealing with medication. Only staff who had completed a recognised course in medication training could take responsibility for administration. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15. The dietary needs of service users were well met with a varied menu of food being served that satisfied their tastes and choices. EVIDENCE: The present menu, currently under review, had been based on the choices, preferences and wishes of service users. Choice of food was available at breakfast and tea. While lunch was a set meal alternatives were available. This was confirmed by service users, visitors and by observation of the lunchtime meal. Food was well presented and properly served including liquidised foods. Tables were well set in the spacious dining room that offered service users and staff ease of movement and service. Apart from breakfast mealtimes were set. None of the service users or visitors expressed any concerns about this. Special diets and foods were readily available. This was confirmed in discussion with the cook. Service users made very favourable comments including “The food’s very nice. I enjoyed my dinner” and “I’m on a diet but they make sure I get enough to eat.” The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. Service users and visitors were assured their concerns and views were listened to and acted upon. EVIDENCE: A complaints procedure was in place detailing how to complain, to whom and giving timescales for response. While reference was made to the regulatory authority, the correct name should be shown together with the right of any complainant to approach that authority at any time. Service users and visitors were aware of how to complain. “If I’m worried I talk to the staff.” “If anything concerned me about my mother I would speak with the staff. If they can’t or won’t do anything about it, I would see Vicky (registered manager).” The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26. Recent investment had improved the appearance of this home creating a comfortable and safe environment for those living there and those visiting. EVIDENCE: The premises were in good structural order. Remedial work had been carried out to the interior and exterior. Of the 19 bedrooms three could be occupied on a shared basis. Some rooms (10 singles) had an en-suite facility. One service user said “I like my room.” Communal bathrooms and toilets were conveniently located on all floors accessed by residents. There was a passenger lift to all floors. Equipment, crockery and cutlery, bed linen, towels and other furnishings were generally of a good quality and in a serviceable condition. Some replacements had been made and others were planned. A secure garden with ramped access was provided with seating. The last reports from the Fire Officer and Environmental Health Officer were seen. Any recommendations made had been addressed. Those parts of the premises seen were warm, clean and free from offensive odours. Appropriate arrangements had been made for the proper laundering
The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 15 of bedding, linen and personal clothing. One visitor commented “It’s always clean, warm and never smells.” An occupational therapist report on the premises was available. Some windows were propped open. Attention was required to the sashes. The registered manager said the handyman was to call and these jobs would be referred to him for attention and resolution. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28. After a period of instability in staffing there is now a good match of wellmotivated staff, committed to training who offer consistency of care to those resident in the home. EVIDENCE: There was a full staff team including 16 care staff (day and night), 2 catering staff and 4 domestics. Appropriate staff cover was provided every day with support from the registered manager. Two waking night staff were employed. Staff were observed to go about their duties quietly and conscientiously. Interaction with the service users was undertaken in a dignified and pleasant manner with an element of humour. A sense of purpose was always evident though encouragement and suggestion were used rather than direction or insistence. Of the 16 care staff four had achieved a National Vocational Qualification in care to at least level 2 and eight were working towards the award at various levels. Service users and visitors were extremely complimentary towards the registered manager and her staff. “They’re all nice and helpful.” “Some are more cheerful than others but we’re not all the same, are we.” “I’ve watched and listened to staff. They give the same attention to everyone. They don’t just concentrate on Mum when I’m here.” The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38. The home was well managed. Proper attention was given to health and safety promoting a safe and secure environment in which service users could live. EVIDENCE: The registered manager was well experienced with many years in the care sector. She had a good knowledge of the needs of the particular service user group accommodated in the home. She was aware of the need to gain a National Vocational Qualification to level 4 in care and management. Visitors were very complimentary in their remarks towards the manager. “I‘ve notice a big difference since Vicky (manager) took over.” “The reception in the home and the willingness to discuss mum’s care is much more open.” “The fact the manager is also one of the owners goes a long way to ensuring improvements are made and stuck to.” A system for gaining service users’, relatives’ and visiting professionals’ views had been devised based on a written questionnaire. This must be implemented as soon as possible.
The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 18 Proper regard was being given to the promotion and maintenance of a safe and secure environment for service users, visitors and staff. A number of satisfactory safety reports and certificates were seen relating to the premises. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 1 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x 2 x 1 x x x x 3 The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 20 NONE. 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 7 Regulation 14(2) Requirement Assessment of service users needs including nutritional screening must be kept under review, revised when necessary and recorded on the current care plan. The medication administration record sheets must be completed at the time medicines are given out. Any reasons for nonadministration must be recorded. The complaints procedure must show the name of the present regualtory authority. It must clearly show any complainants right to approach that authority at any time. Broken window sahses must be repaired or replaced. The system devised by the registered providers for quality assurance and quality monitoring must be implemented, responses recorded and evaluated and adjustments made to the care, services and facilities as necessary. Timescale for action 31/05/05 2. 9 13(2) 04/05/05 3. 16 22 31/05/05 4. 5. 19 33 23(2)(b) 24 31/05/05 31/07/05 The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 3 7 28 31 Good Practice Recommendations The pre-admission assessment forms should be signed and dated by the person completing them. The care plans should be signed by the service user or their representative. The registered providers are reminded of the need for 50 of the care staff to have achieved a National Vocational Qualification in care to at least level 2 by 2005. The registered providers are reminded of the need for any registered manager to have achieved a National Vocational Qualification in care and management to level 4 by 2005. The Holt v224947 j53 j04 s50401 the holt v224947 040505 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unit 4, Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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