Inspection on 11/10/07 for Holwell Villa

This inspection was carried out on 11th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Holwell Villa 20/08/08

Holwell Villa 08/05/06

Holwell Villa 20/12/05

Holwell Villa 20/09/05

Holwell Villa 08/11/04

Holwell Villa 07/07/04

Holwell Villa 12/03/04

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 Holwell Villa Holwell Villa 119 New Road Brixham Devon TQ5 8BY Lead Inspector Judy Cooper Unannounced Inspection 11th October 2007 02.00p. 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 Holwell Villa DS0000018373.V348739.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. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holwell Villa Address Holwell Villa 119 New Road Brixham Devon TQ5 8BY 01803 854103 01803 859669 howell.villa@btinternet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ronald Frank Marlow Mrs Barbara June Marlow Christina Marie Thomas Burridge Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (17) Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Females may be admitted from the age of 60 Mrs Burridge to complete her Registered Manager`s Award within the next twelve months 8th May 2006 Date of last inspection Brief Description of the Service: Holwell Villa offers accommodation with personal care to older people (60/65 ), older people with a physical disability and older people with dementia. It is registered to provide a service for up to 17 people both male and female. The manager also accepts day care clients (up to a maximum of two a day, when the home has the capacity to do this). The home is laid out over 3 levels and has a passenger lift connecting the ground, first and second floors. With regard to private accommodation, there are 11 single bedrooms (2 of which have en suite facilities) and 3 double bedrooms (2 of which also have en suite facilities). There are communal bathrooms and toilets throughout the home, including an adapted walk-in shower room. In terms of communal space, Holwell Villa has a lounge and a dining room as well as a front garden and a contained rear patio area with seating. The building is a large detached property located within walking distance of Brixham town centre with its range of shops and amenities. There is some parking to the front of the property with easy accessibility to the front door of the home. The inspection report is held in the homes office and is available, on request, to any interested person as is stated in the home’s statement of purpose. Current weekly fees range from £315.00 to £360.15. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on Thursday the 11th October between 2.00p.m and 6.00p.m as well as the following day, Friday the 12th October, between 10.00 a.m. and 6.00p.m. Opportunity was taken to observe the general overall care given to the people who live at the home. The care provided for four people was also followed in specific detail, from the time they were admitted to the home. This involved checking that all elements of their identified care needs were being met appropriately. A tour the premises, examination of some records and policies, discussions with the manager, the people who live at the home (who were able to converse) and those staff members who were available, as well as two visitors to the home, also formed part of this inspection. Additionally the staff on duty were observed generally, in the course of undertaking their daily duties. Other information about the home, including the receipt of five completed questionnaires from those living at the home, six from relatives/advocates, seven from staff members and two from other interested parties, has provided further feedback as to how the home performs. Also during the visit, on the second day, a period of an hour and a half was spent sitting with some of the people who live at the home, observing how they spent their time and the contact they had with staff and others. This approach aims to try to understand the experience of people who live at the home who may have difficulty in communicating this verbally, because of their mental frailty. Information received from all of these sources has been used in the writing of this report. All required core standards were inspected during the course of this inspection. What the service does well: The manager continues to ensure that an “open door” policy is in place, which allows the people and their relatives/advocates as well as staff, the ability to speak openly and easily with her. The manager and staff strive to provide individual care for the people, some of whom are unable to communicate their needs due to mental frailties. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 6 Holwell Villa offers an informal environment where a very relaxed, family atmosphere is maintained. People benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other. The result of this is that they can benefit from companionship with each other as desired and are therefore not isolated in any way, unless they choose to spend time alone. There is a strong staff group currently employed at the home. Although there has been a large turnover of staff members at the home within the past year the current, mostly new staff group, some of whom were already experienced in working with the elderly as well as being suitably trained, were noted as working well together as a team. This helps ensure that the care given is done so in the best interests of the people who live at the home. What has improved since the last inspection? What they could do better: The home’s statement of purpose and home’s service user guide must be provided to any prospective person and/or their relative/career prior to their admission to the home. This will then ensure that a prospective new person and/or their family/advocate is aware, prior to admission, exactly what facilities and services the home can provide. The management must forward a confirmation letter to each prospective person, following their pre-assessment, stating that the home will be able to provide the appropriate care for his or her current health and welfare needs. This is so that each prospective person and/or their family/advocate can be sure that the home knows and agrees to meet their needs. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 7 The care plans for each person must contain detailed, relevant and in depth information in relation to their personal and social needs and changes to these needs. This information should be held in one central location for easy reference. The care plans should be complied, as far as possible with the person themselves and or/their family/advocate. This is to ensure that any care provided has been agreed with the person and/or their family member/carer and that all are happy with the care to be provided and with the manner it is to be delivered in. All care plans must also be reviewed monthly with the same person, if possible, for the same reasons. The reviews should also clearly reflect any changes to the care to be given, how the care provided will meet these changes as well the reasons for the changes. The home’s daily records should also contain full, detailed information as to the care required/made available during each day/night. This is so that all staff will be aware of any immediate changes to a person’s needs and will be aware of what care to deliver to meet these. The privacy of all people who live at the home must be maintained at all times. In particular a screen must be provided, within shared rooms, to maintain the privacy and dignity of those people who are accommodated within a double bedroom. Any form of restraint used i.e. a cot side, must always be regularly risk assessed by the home’s management, with advice sought from outside professionals, as well as agreement obtained from the person and/or their family/advocate as to the use of such restraint. These details must be kept in the individual person’s file at all times. This is to ensure that any form of restraint used is always in the best interests of the individual person and fully meets their individual needs, whilst at the same time respecting their right to freedom and choice. The home’s activity programme should be reviewed to ensure that all peoples’ needs are being met and that activities being planned to be offered are both achievable and deliverable. A record should be kept of what activity has been provided on what day and who participated, so that the management of the home can easily keep a record of which activity is enjoyed and proves popular and which, if necessary, needs adjusting, to ensure that all people who live at the home are able to participate in some form of meaningful activity. This is to ensure that all the people who live at the home have an opportunity to enjoy various activities suited to their own dependence levels. To ensure the people remain protected an up to date complaints policy must be easily available to the people and all other interested parties at all times within the home. The upgrading programme of the fabric of the home should be continued to ensure that the home is fully brought up to the required environmental Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 8 standards to ensure that the people are able to live in an attractive, well presented and well maintained environment. For example his should include such things as redecorating the areas of the home that appear to be shabby and tired such as the downstairs hallway and renewing chipped paintwork to the doorways on the third floor and improving the lighting within the home in communal areas such as in the downstairs hallway and communal toilets where the current lighting does not provide a bright light. (Further details of environmental shortfalls noted can be found within section headed ENVIRONMENT, contained within this report). Also to ensure that the people are fully protected from the risk of sustaining a scald should they inadvertently fall against an exposed hot surface, the area of radiator within the home’s communal lounge area, which is currently easily accessible, must be covered. Additionally to ensure that the people remain protected from the risk of falling from an unprotected, wide opening window a suitable window restrictor must be provided for the window sited on the middle landing. As the home is currently providing care to people deemed to have severe dementia, which has resulted in communication difficulties, specialist communication training should be made available. This so that all staff are fully aware of how good and meaningful communications can be made with those people who have lost the ability to easily communicate verbally. The home’s recruitment programme must be undertaken in a robust manner to ensure suitable people only are employed to work at the home. This must include obtaining two written references for each staff member employed. The management must provide regular supervision to all staff and keep records of the same. This is to ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member the opportunity to discuss any issues regarding their role. This will allow then the management of the home to monitor the progress of each staff member and to offer support/training as required. The owners and registered manager must undertake a formal quality audit of the service, which must include seeking the views of the people who live at the home, their relatives/advocates and any other interested parties, including other professionals, that may have contact with the home. The management must then act on the information received by producing an annual development plan for the home taking into account this feedback. This is to ensure the home is always run in the best interests of the people who live there. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 9 The owners/manager must ensure that all the required homes’ policies and procedures are both complied and made available, including a moving and handling policy and a discharge policy. This is so that all staff are aware of what health and safety precautions they need to be made aware of during their work and of what criteria they need to work to, to enable them to provide the required care to the agreed standard at all times. The registered manger must complete the relevant training required for managers. This includes obtaining a National Vocational Qualification in management at level 4. This is to ensure that the manager is fully trained and skilled to be able to supervise and direct staff appropriately in the delivery of the best possible care to the people who live at the home. 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. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 10 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 Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 11 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): Standard 3 (standard 6 is not applicable as the home does not provide intermediate care) The quality in this outcome area is adequate. The home’s pre-admission assessment process does not always contain enough information to ensure that all staff would be aware of a new person’s needs. Also pre-admission documentation had not always been provided to prospective people and/or their families/carers, prior to admission, which meant they would not have had up to date information about the home and the services and facilities that could be expected prior to admission to allow them to make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three people who had had planned admissions within the past twelve months were inspected and these were seen mostly to be in order with pre-assessment visits having taken place at two of the peoples’ previous address prior to admission. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 12 The third person’s needs had been known to the home as they had been previously attending for day care. A basic assessment of need was seen, however these assessments did not fully detail the prospective person’s needs. It was also noted that a new pre-admission assessment had not been completed for the person who had previously been coming to the home for day care. This should have taken place as the person’s needs had changed, since they commenced day care services, which had resulted in the need for a permanent placement. Neither was there any form of written communication to evidence that the management of the home had confirmed with each prospective person and/or their family/advocate that the health and welfare needs of the person, to be admitted, had been agreed as being able to be met by the home, prior to admission. Therefore the prospective person and/or their family/advocate would not have been certain that the home both knew and had agreed to meet their needs. Evidence that also support this includes confirmation from one of these person’s carers, who was visiting during the inspection, who was spoken with and who confirmed that they had not received any documentation prior to the person’s admission such as the home’s statement of purpose or service user’s guide, whilst a feedback comment received, prior to the inspection from a person already living at the home, stated: “I did not receive information about home prior to living there”. Although this information is easily available within the home, an individual copy must be given to each prospective new admission and/or their family/ advocate so that all parties can be aware of the services and facilities the home can offer, prior to admission. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10. Quality in this outcome area is adequate. Peoples’ health and personal care needs are mostly being maintained to a reasonable level. However people who live at the home could be at risk by staff not fully monitoring peoples’ behaviour and seeking early professional intervention as needed. In some instances peoples’ privacy needs were not always being maintained, and at times communications between some staff and those people who have communication problems were not always undertaken in such manner as to ensure that the person was involved in and aware of the care provided for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Basic care plans were available for the people who live at the home. These were kept in the newly created office area within the home. Although the newly formatted care plans contained basic social, healthcare and medical needs there was some gaps in the information provided. For example, one person has moving and handling needs as well as delicate skin which had Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 14 resulted in District Nurse intervention due to the person sustaining two skin lacerations which may have been due to moving and handling issues, however this was not documented within the care plan. Therefore this would not allow a carer reading the care plan to have full understanding of the needs and how best to provide correct care. The District Nurse services have also recently provided four hospital beds for use within the home. Two of these beds were noted as having cot sides in place, which are used, however there were no records in place in relation to the use of these informing carers why the sides are to be used and how. The decision to use the cot sides must always be discussed with the person involved or their family/advocate as well as professionals involved to ensure that this form of protection is considered to be in the best interests of the person concerned. Care plan reviews had been carried out on a monthly basis, however the actual review contained very limited information, with regular comments such as: “no change” or “slight change”. This does provide enough information for those caring for the people on a daily basis and may mean that inappropriate or wrong care is provided by staff who have no awareness of what the comments: “no change” or “slight change” may mean. For example a comment received prior to the inspection stated: I have recently asked for my mothers food (meat) to be liquidised, a practice that was stopped when a member of staff left. I think it is very important”. Details and changes like this, if discussed with the family member and then recorded in the care plan review, would give a clear indication as to when and why a certain practice has been changed and would then allow all parties, including the person’s family member and staff, to know what course of action had been agreed. There were daily records available and in some instances these were in depth and thorough allowing carers to have easy access to what care had been provided each the. However for some others the daily entry read only: “as care plan”. In these instances there were no further explanations as to what actual care had been or was to be provided and how any new needs had been or were to be resolved. During the inspection the care of one of the people whose care was looked at in detail was discussed with two of their visitors. They had had some concerns over the care of X and had previously spoken with the manager who they stated they found easy to approach and who had taken steps to deal with their concerns. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 15 Further discussions, took place as part of the inspection, and the manager was able to inform the inspector of the action she had taken and was further going to take to ensure that the person’s care was provided for as needed. However there was little documented within the person’s care plan/review process to indicate what changes to the person’s care practices had actually been put in place. Additionally it was noted that this person, who chose to eat in their own room, still had tray of uneaten food in their room at 2:30 p.m., which the manager then immediately had removed. As it is this person’s weight is currently being monitored, this was not seen to be good practice, as it was not clear, by this time, whether the person had simply chosen not to eat the meal or whether they did not like the food. Therefore correct information could not be recorded within the daily record or care plan, which would help inform future care practices. Although the manager will react appropriately to concerns and do all possible to rectify them thereby ensuring that people feel confident to approach her, newly presenting needs and ways to meet them do need to be fully documented so that care staff provide the correct care. The home’s medication systems were inspected. Medication administration was noted in order with medications stored securely and noted as being administered correctly and signed for appropriately. A photograph of most of the people was seen to be on their individual medication records other than for a newly admitted person and this was in the process of being undertaken. Only designated senior staff administer medication and when speaking with the senior carer mostly responsible for this task she was able to evidence a clear audit of the medications into the home and of any disposed of. All staff involved in the administration of medication had received relevant medication training and there are good links with the local supplying pharmacist. The people observed during the inspection were noted as being treated by staff with respect generally their dignity was preserved. However to ensure that peoples’ privacy rights can be maintained within a sharing room there is a need to provide screening in all of the three double rooms within the home (currently only one room has this facility). It was also noted that staff interacted in a professional and relaxed manner with the people at the home, which helped foster good communications. However, following the use of the observational tool used during the second day of the inspection, it was noted that those people with very limited communication skills were not with communicated with in as meaningful way as those who still possessed better communication skills communication skills. This meant that these mentally frailer people had less communication with staff at times than others. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 16 Other professionals regularly visit the home as required including District Nurses, Community Psychiatric Nurses, Occupational Therapists, Physiotherapists, and a chiropodist etc. The District Nurse services have recently had a lot of input into the home in terms of providing training to staff, following some general concerns they had over the level of care provided, in particular with reference to moving and handling and providing necessary care for a very frail person. The District Nurse services have tried to ensure that the manager and staff are now better able to provide the required care. Feedback obtained, prior to this inspection, from the District Nurse team leader confirmed that, since their input into the home, the District nurse team generally felt that the specialist care required had improved and that staff were now more aware of the peoples’ needs and were now better able to meet them. She also reported that communications between the home’s staff and the District Nurse service had also improved which meant, ultimately, the needs of the people who live at the home are now being better met. It should also be stated that there were many very positive comments received, prior to the inspection, from the relatives/advocates of those that live at the home which included such comments as: Very happy in the way they care for X’s need’s They will always ring or inform me of any problems They are quick to tell me about any important issue X is a very exceptionally difficult person to look after and they cope very well The staff are very caring The home manages X’s care needs with the utmost patience and care” I am very pleased with the care X receives from the home The staff treat those who use the service with a caring nature seeing to their needs as they arise” Staff use humour to overcome some difficulties which is good” I have always been pleased by the way staff speak to and care for all the people in the home”. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 17 On that whole I am very happy with the level of care X receives. She is comfortable and seems to be content. “Cheerful atmosphere. The staff are pleasant with people who are sometimes difficult Practices a very secure, caring home with residents individuality promoted. The care I feel is informative to involve family members whilst at the same time respectful of service users’ privacy/confidentiality. One doctor’s feedback also included the comment: I am very happy working with all the staff concerned. They appear caring and seemed to always know what is going on. Therefore although there have been some identified shortfalls as noted the actual care delivered is thought of highly by many relatives etc. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 18 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 adequate. Most people who live at the home are generally well supported to pursue their chosen lifestyles however on occasions less able people who live at the home are not consulted over lifestyle choices. The home’s activity programme does not always meet everyone’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Several people at Holwell Villa have a high degree of dependence. During the inspection, most were noted to be in the home’s communal lounge areas however some more independent people confirmed that they often chose to remain in their own rooms and this was clearly facilitated. A feedback comment from a person at the home stated: “I have complete freedom to do what I wish to do”. The home cares for people who live at the home with very differing needs and tries to provide for these needs very individually. For example one person has expressed an interest in going back to the church she used to worship in. It was pleasing to note that the manager was doing all Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 19 possible to facilitate this by providing staff members to accompany her when she chose to go. People who were sitting in the communal areas of the home, were noted as mostly chatting with others, watching T.V or wandering within the home’s hallway/lounge. There is no restriction on liberty within the home, however for peoples’ security the front door is opened only after utilising a numbered key pad. This helps ensure the safety of the people who live at the home and allows them to wander throughout the hallway and lounges freely. Some comments contained within the feedback, received from various sources prior to the inspection, indicated that they felt the home’s activity programme does not always meet all the needs of the people who live at the home. Examples of such comments received included: Maybe the odd outing for X may be of benefit” Possibly introduce more activities/outings for those who are able, to provide more of stimulation I visit in the mornings and usually the TV is on. Nobody watches. Usually wartime music is played and this is popular, as most of the people know the words. I think there are more activities in the afternoon. Stimulation is what some people need and respond to well”. To improve one thing would be to take the clients out more often The manager stated, in the home’s pre inspection documentation, that she was aware that the home’s activity programme needed some additional input and that she and her staff had recently compiled a new activities programme, which was noted as being displayed during the inspection. The manager has also arranged for some external entertainers to visit the home in the near future, such as bringing animals for the people who live at the home to touch and stroke. During the better weather some, but not all, of the people did have the occasional trip out, with some going to the local shops, local beauty spots and the zoo etc. A letter has recently been sent to peoples’ families/carers informing them of the home’s intention to provide outings when possible. It was also noted that the letter indicated that these outings would be charged for, either from the person’s own monies, held within the home, or the family/advocate would be billed, and they were not being freely provided by the home. However it was also noted that, on the one of days of the inspection, the activity being provided was not the one detailed on the displayed activity programme, as the correct staff were not available to undertake the activity. The activity programme is mostly undertaken by the staff members themselves and although it was noted that one staff member was playing a Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 20 large size dominoes game with a few people, several others were not engaged in any activity other than by occupying themselves in talking to others, or singing along to the music that was playing etc. which for some very dependent people was not possible for them to do. Therefore there were periods of time when some people had very little to occupy them. The home maintains an open visiting policy and the visitor’s book, sited within the home’s hallway, demonstrated that the people had visitors at differing times and the three visitors spoken to confirmed that they were always made welcome and could freely visit at any time. Although the majority of the people were not fully able to express themselves it was noted that choice was often made available, for example at mealtimes when people were asked what they wanted and time and encouragement provided to elicit a response. Also people were noted as being asked where they wanted to go following their tea, with the choice being to remain in the dining room or go through to the home’s main communal lounge and again in most instances their response was waited for and their choice acted upon. However there were instances when this did not happen and a person was not asked what they wished to do, or even told what would be happening, for example following tea one person was just wheeled into the lounge without any communication taking place between the staff member and the person. Therefore it could not be concluded that everyone is always given some choice over day to day lifestyle choices. Menus were examined and a meal was taken with the people on the second day of the inspection. This was a selection of fresh Brixham fish which, had been provided by a local fisherman and was much appreciated and enjoyed. Stewed fruit and custard followed this. An alternative was provided for one of the people who did not like fish. Mealtimes were noted as being a relaxed, congenial and unhurried occasion and comments received about meals provided were favourable such as: Mealtimes are excellent with one-to-one feeding as needed and “Proper homemade cooking. Plenty of tea and coffee”. Since the last inspection the previous long serving cook has left. However a new, experienced trained cook who clearly understood the needs of the elderly has replaced her. During conversation she also confirmed that she gets enough good ingredients and fresh vegetables to make good meals. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 21 Those people that needed support with feeding were noted as being given this support in a sensitive and encouraging manner, which, ensures that these people can also enjoy their meals in an unhurried manner. The menus seen reflected a varied and wholesome diet with alternatives provided based on peoples’ needs and preferences, for example one person was noted as having meat instead of the fish. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 22 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): 16,18 The quality in this outcome area is adequate. Arrangements for protecting the people who live at the home and responding to their concerns are satisfactory. However not everyone was aware of how to make a complaint to the Commission if they should wish to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although the home’s complaint procedure is contained within the home’s statement of purpose it was not being displayed within the home on at the commencement of the inspection and feedback, received prior to the inspection, indicated that not everyone knew the home’s complaint policy. However, the 3 visitors spoken with, did confirm that they felt able to approach the management or the staff with any worries they may have as did some relatives/advocates in their feedback received prior to the inspection. The Commission has received one complaint and has been made aware of some general concerns since the last inspection carried out in May 2006. These have included environmental issues, communication problems and general day to day care practices. The manager investigated the complaint and concerns in a timely and professional manner. She used the information gained from her investigations to improve the practice within the home. For example, an agency worker had felt they had not Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 23 been given an adequate handover and report when they commenced duty at the home. The manager responded by creating a more easily accessible information system within the home. The manager stated, and the staff confirmed, that they have received vulnerable adult training and were aware of how to deal with any allegations or concerns regarding abuse issues. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 24 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 adequate. Some ongoing general improvements/upgrading measures have allowed Holwell Villa to provide a reasonably pleasant environment to live in. However, further upgrading needs to be undertaken to ensure that the whole home is of a good environmental standard throughout. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The tour of the home confirmed that some general upgrading of the home continues to take place. The home’s kitchen has been recently been fitted with an air-conditioning unit. A new permanent ramped area has been provided to the rear corridor and staff confirmed that this has improved access. Further upgrading has included the provision of new chair covers in the communal lounge area and some redecoration within the home. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 25 There are also imminent plans in hand to provide updated laundry equipment which will include a new washing machine and tumble drier, which will further improve the laundry service. Although it was noted, during the inspection, that the people who live at the home were dressed in clean, well maintained clothing one feedback comment stated that the one thing within the home that could be improved would be: “Better care in cleaning of clients’ clothes and mending such as buttons put back on as badly as badly dressed clients reflect badly on the home”. Peoples’ bedrooms throughout the home are personalised as desired and people are able to bring in personal items with them.. The home will provide a suitable bedroom door lock if requested, but they are not provided as standard on admission. The lounge and dining areas provide adequate space and are reasonably well appointed and attractive. Plans remain in hand to create further lounge and dining areas by the erection of large conservatory at the front of the house. Plans also remain in hand to create a larger more easily accessed toilet by knocking two smaller toilets into one. Both sets of plans have been in place since the last inspection in May 2006. However due to difficulties in getting planning permission the work has not yet commenced. Since the last inspection a small office area had been created on the ground floor of the home by converting the previous dry food store into a small secure office area. However the dry food storage is now sited in a cupboard on the top floor of the home and is not considered to be in the best place as it is not within easy reach of the homes kitchen. Also during the inspection several environmental shortfalls were noted which included: a) the en-suite bathroom for room 18 was full of items of furniture and brica-brac that did not belong to either of the two people who share this room. These should be removed b) The carpet strip between the en-suite bathroom and bedroom area of this room was lifting. This could cause a trip hazard and should be fixed. c) It was noted that in certain areas of the home, for example in the home’s entrance hall and in some of the homes communal toilet the lighting was dim. This could cause a problem for the people using these areas who have poor eyesight. d) One shared double bedroom was noted as not having enough easy chairs to allow a regular visitor to sit anywhere other than on the person’s bed. e) An area of exposed radiator within the home’s communal lounge area, is currently easily accessible to the people living at the home which may Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 26 cause a person to sustain a burn if they were to lean on it and it was very hot. Covering must be put in place as soon as possible f) A wide opening, window on the middle landing did not have a window restrictor in place. This could pose a risk to anyone who tried to climb through the window and a restrictor must be installed as soon as possible. g) Some other general maintenance shortfalls were noted. For example in the downstairs communal toilet the toilet lid was noted as being missing. Due to this a large unprotected sharp screw was protruding from where the lid would be fixed and this could cause a scratch or tear to someone using this toilet. Other examples included some missing light shades, an incontinence odour in one of the rooms, whilst the chair in the same room was left damp following cleaning of the chair which would mean that should the person, occupying the room, have sat in the chair it would have been wet and uncomfortable. There were also some marks and chipped paintwork noted on doorframes etc throughout the home. h) The window height in one of the rooms has been raised to both protect and prevent the person who occupies this room from using the window opening inappropriately to throw waste outside the home. However by raising the window height the person no longer has the view from the window when seated. This decision had not been made with any involvement from any other professional although the manager stated that they had received permission from the person’s family. Therefore the person’s quality of life would be compromised when the person was sitting in their room. i) The inside of a double glazed units on the back stairway was noted as being very dirty and should be cleaned to ensure that the general appearance of the home is pleasant. j) A raised strip has been put in place in the walk-in shower to stop water drainage onto the carpet outside the shower. However the strip, being narrow and low (approximately 1”) from the ground is hard to see and may cause a trip hazard, which would be hazardous for anyone using this facility. As this room currently houses the hand washbasin serving the communal toilet next door, it is probable that a person may use this room unsupervised. k) The communal toilet on the top floor does not have a sink unit. This could cause a risk of cross contamination as a person would not be able to wash their hands prior to opening the door. l) The same is true for the staffs’ toilet. Staff currently have to use the sink either in the next-door laundry room or in the kitchen. Again this could cause a risk of cross contamination. m) It was noted during the inspection that there was a mattress propped up behind the door in the dining room. The manager stated that this was used by the sleep in member of staff at night unless there was a spare bedroom. It may be in the interests of the home to consider a more suitable sleeping in arrangement, although staff when asked, felt that sleeping-in within the communal dining area, once the people had Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 27 vacated the room ensured that they could easily hear if they were needed. However should this practice continue the mattress must be stored out of the way of the people at the home to prevent any injury and because it was unsightly in the current position. The management maintains the day home’s fire precautions in line with the requirements of the local fire department. During the inspection an external fire trainer was present to deliver training to all the staff whether on or off duty and it is a credit to the staff that they all attended. The fire trainer was able to confirm that the home complies with the necessary requirements attached to ensuring that the people in the home are protected from the risk of fire. The homes environment was mostly seen as clean and hygienic with such things as bacterial hand wash, gloves etc easily available to staff. A comment received stated: “ Home is always very clean”. However, as previously mentioned, there was an odour of incontinence in one bedroom and lack of hand washing facilities in a communal toilet and in the staff which will increase the risk of cross infection. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 28 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): 27,28,29,30 Quality in this outcome area is adequate. Staff at the home are employed in adequate numbers to meet the peoples’ needs. The home’s recruitment programme was not fully robust and may not protect the people at the home. Some peoples’ quality of life is being compromised due to some staff not having received specialist training on how to communicate effectively with the more mentally frail people who the home provides care for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota/numbers was discussed. The manager tries to ensure that there are always three carers on duty during the morning two in the afternoon/evening supported by ancillary staff including a daily cleaner and a designated cook including at the weekend. The manager works from during the week and at weekends and when she is not on duty there is a senior person designated to take responsibility for each shift. At night there is a waking night carer from 8.00p.m until 8.00a.m and a sleep in carer from 8.00p.m until 8.00a.m who sleeps between the hours of 10 p.m. and 6 a.m. only. A meeting took place with most of the staff members as they were present for the required fire training. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 29 Staff spoken to confirmed that they felt there was sufficient time to provide care for the people and that the time provided also ensured that they were able to spend some time with each person as required. All were positive about working at Holwell Villa and felt that the new staff team worked well together providing support for each other and the people at the home. Comments received from staff included: “We treat everybody as a person and not just a number. We try our best to keep them in the lifestyle they are accustomed to. All residents come first above everything else Staff work well as a team We look after the clients well. There is good staff support. I have been at this home for some years. I always enjoy coming it is a great home to work in and the management are very approachable. Everyone works really well as a team and we always make sure that the residents are happy and enjoy their time here to the full. The home is not only my job is a large part of my life. Everyone here, staff residents and families are all one big family. They say home is where the heart is and mine is definitely at Holwell Villa. I have only been employed for three weeks but as far as I can see the care for the residents is excellent. Residents are happy and well looked after and there is a happy atmosphere from both residents and carers. It feels like the residents are family. We know them as individuals. There is 100 concentration on them. As the staff group is a fairly new one it is to the manager’s credit that staff feel so positively about their role and working at Holwell Villa. Since the last inspection there has been a very high turnover of staff. This has resulted in the appointment of 11 new staff since last inspection, whilst only five staff remain from the previous staff group. Four of the new staff members’ details were inspected. It was noted that there had been a robust recruitment process for each staff member and the manager had obtained a Criminal Record Bureau check for each staff member. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 30 In some cases, previous staff had returned to work at home following a period pursuing another job etc. The manager had also ensured that police checks were undertaken for these returning staff members. The home employs some overseas workers, however when checking the details or one of these people it was noted that only one reference had been provided by the agency used in the recruitment process rather than the two required. The training programme within the home is good. Several staff members already have National Vocational Qualifications in care and are committed to undertaking further training. The current level of trained staff is well over the required 50 , which therefore means that a trained and aware staff group cares for the people. Three staff had also just commenced specialist dementia training at a local college whilst regular in house and external statutory training is also provided. Staff spoken to were committed, enthusiastic, professional and motivated towards ensuring that the people who live at home are well cared for and that their quality of life is as good as they can make it. One staff member was noted as not having had any previous experience in care, however they were able to confirm that with the support of the manager and other staff in the home, they had begun to feel confident within their role. Inexperienced staff undertake an in-depth induction programme which is in line with the General Social Care Council’s code of conduct and practice. Incorporated within the induction programme is training in first aid, moving and handling, fire safety, protection of vulnerable adults, infection control and the safe handling of medications. Prior to the inspection there was some feedback received that communications between staff, the people living at the home and other professionals could be improved as there had been occasions when other professionals had felt that communications were sometimes misunderstood. As previously mentioned, during the inspection it was noted that on occasions the more mentally frail people did not receive the same level of staff interaction, from all staff members, that the more able people did. It was evident that this was not an intentional practice but rather a lack of understanding as how to best provide communication in these instances. The findings were discussed with the manager who also confirmed that she felt this was a communication issue that she would now address through training. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 31 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): Standards 31, 33, 35, 36 and 38 (parts of standard 37 were also inspected but the standard was not inspected in full): Quality in this outcome area is adequate. The service benefits from having a consistent manger who is approachable and well thought of. However the home is not currently ensuring that it is run in the best interests of the people who live at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has completed her registered manager’s award but also needs to undertake a National Vocational Qualification at level 4 in care. The management of the home has undergone some major changes since the last inspection in May 2006. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 32 The deputy manager has left the employment of the home and a previous carer has now taken up the role as head of care supporting the manager but mostly dealing with care issues whilst working in care in the home. The consequence of this is that the manager has less support and is spending more time completing the necessary management and administration tasks and so consequently has less time to spend in a “hands-on” role within the home. Since last inspection there have been some identified shortfalls, which are contained within this inspection report. In discussion with the manager it was concluded that due to time constraints she has been less able to supervise staff as she used to and this has led to care practices being undertaken without her being always able to oversee and agree them. However the relatives and staff at the home spoke highly of the manager’s role at Holwell Villa with comments received such as: The manager puts 200 of effort into her work to show us how to look at after the clients. I am very happy with her as manager as she is loyal and loving to all staff and clients and I am sure that it is seen by all who visit the home. The home obtained the “Investors in People” award in November 2005. Although the manager continues to undertake quality auditing on an informal basis using such feed back as resident and family questionnaires etc a formal quality auditing system has not yet been in place. Neither is there an annual development plan addressing any noted shortfalls r building on any strengths etc. Therefore there is no way to verify that the management can gain the views of residents, their families/carers, or other stakeholders as to whether the home is working in the best interests of the people who live there. The manager stated that, as previously, peoples’ families/advocates mostly deal with any financial matter appertaining to them. The owner is an appointee for one person, a position she has held for many years. The home holds small amounts of monies for t people who live at the home, as required, and there were adequate records in respect of this, which protects their financial affairs. Other records inspected during this inspection included the fire log book, the homes accident reporting, and some of the homes policies and procedures. It was noted that although the policies and procedures had been reviewed and updated some necessary ones were not available. This included a moving and handling policy. As there has been some recent concerns over moving and handling issues within the home and the fact that the home is registered to provide care for people who live at the home with physical dependencies, it is important that staff have a policy that they can Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 33 refer to ensure that they are aware of the latest guidance and the homes expectations. It was also noted that there was no discharge policy for when a person moved a different home etc. Discussion with the manager concluded that formal, recorded supervision does not take place. Although, overall, staff had very favourable comments about the manager, formal staff supervision must be provided to ensure that both the staff member and the manager are aware of, and happy with, the staff member’s ability to provide the required level of care. A feedback comment received from a staff member evidenced this with: “manager does not provide one-to-one supervision. Sometimes we have to ask the support to should be given”. Regular, planned supervision would overcome these problems. Health and safety within the home is maintained to a reasonable standard with the manager confirming that necessary health and safety procedures are in place within the home. However due to environment shortfalls previously noted under environment i.e. a hot surface not fully protected and a window restrictor not in place, the home does not always provide a safe environment for the people who live there. The security of the home is satisfactory with a keypad system being in situ at the front door of the home. To exit the home it is necessary to be able to remember a series of numbers. For those who are more mentally frail and for whom leaving the home unaccompanied would constitute a risk, having such measures in place for exiting the home helps protect them from unnecessary risks. There is a safe outdoor area at the rear of the home, where people can enjoy being outside. Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 34 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 2 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 2 x 1 x 3 x 2 2 Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? N/A. None issued. 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 OP1 Regulation 4, (2) and 5 (2) Requirement The management must ensure that an up to date service user’s guide and a home’s statement of purpose is made available to any prospective new person and/or their family/advocate who might be considering/acting for someone considering living at the home. This is so that all people who live at the home and any prospective person considering coming to live at the home will be aware of the services and facilities available at the home. The management must confirm in writing to the prospective person that the home will be able to meet their assessed health and welfare needs. The management must ensure that all people using the service have an up to date, detailed care plan. Care plans reviews must also reflect any changes regarding the care to be given and the reasons why the changes are to be made. DS0000018373.V348739.R01.S.doc Timescale for action 12/12/07 2 OP3 14 1 (d) 12/12/07 3 OP7 15 (1) and (2) (b) (c) 12/12/07 Holwell Villa Version 5.2 Page 36 4 OP8 13 (7) The care plans, and subsequent reviews should be complied, as far as possible, with the person themselves and or/their family/advocate. This will ensure that the people who live at the home receive person centred care and support, that has been agreed to and meets their needs. The use of restraint measures 12/12/07 such as cot sides must be risk assessed and advise sought as to the extent and use of such restraint from other relevant professionals. This will ensure that the peoples’ health care needs are being met. 5 OP10 12 (1) (a) The management must seek medical, or other professional intervention, as soon as a medical or any other problem is noted. This relates directly to contacting a GP regarding a persons weight loss and a relevant professional regarding a decision to alter the positioning of a window height to help deal with some behaviour issues. This will ensure that people receive appropriate care to meet their health care needs. The management must ensure that there is an up to date complaints procedure easily available within the home. The owners/management must ensure that the home is maintained to a good standard and kept in a good state of repair externally and internally. This will ensure that the people DS0000018373.V348739.R01.S.doc 12/12/07 6 OP16 16 (1) (3) 12/12/07 7 OP19 23 (2) (b,c,d,i,j,l, p) and 3 (b) 12/06/08 Holwell Villa Version 5.2 Page 37 8 OP19 13 (4) (c) in the home live in a comfortable pleasant, environment, which meets their needs. The management must ensure that unnecessary risks to the health or safety of the people are identified and so far as possible eliminated. This refers specifically to providing: a) a window restrictor to the middle floor landing window and, b) to the covering of the exposed hot surface within the communal lounge. This so that the people who live at the home can live in a safe, risk free environment 12/12/07 9 OP29 19 (4) (b) 10 OP30 18 (1) (a) 12/12/07 The management must ensure that there is a robust recruitment programme operating within the home, which includes the receipt of two written references. This is so that the people who live at the home living at the home will be cared for by suitable staff and will remain protected. The management must ensure 12/01/08 that suitable staff training is made available, including the provision of specialist communication methods for people who live at the home with degrees of severe mental frailty. This will ensure that the people that the home provides care for can be assured of receiving appropriate care. The registered manager must 12/10/08 ensure that she obtains the qualifications required by someone managing a care home. DS0000018373.V348739.R01.S.doc Version 5.2 Page 38 11 OP31 9 (2) (bi) Holwell Villa 12 OP33 24 (1) (a) and 2 This relates specifically to her obtaining a level 4 National Vocational Qualification in care. This will ensure that someone who is appropriately qualified and experienced manages the home. The management must introduce a structured system to monitor the quality of the service provided. This should include the views of people who live at the home (if possible) and other stakeholders including relatives/ carers and other professionals. An annual development plan should then be complied using this information. This report must be made available to the Commission. This will ensure that all involved in the receipt of care are able to have a say into how that care is delivered. 12/06/08 13 OP36 18 (2) 12/03/08 The management must provide regular supervision to all staff and keep records of the same. This will ensure that all staff have the opportunity to have individual time with the management of the home and to allow the staff member to discuss any issues of their role that they may wish to have extra support with. It will also allow the management of the home to monitor the progress of each staff member and to offer support/training as required. The management must ensure 12/01/08 that all the necessary polices and procedures are provided for all staff to follow. This particularly relates to compiling a policy on moving and DS0000018373.V348739.R01.S.doc Version 5.2 Page 39 14 OP36 24 (1) (a) (b) Holwell Villa handling and on discharging a person to a different setting. This will ensure that those working at the home are aware of the expectations and guidelines in place to ensure that a good quality of care is provided as laid down in the home’s polices and procedures. 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 OP3 Good Practice Recommendations The manager should enlarge the current pre-admission assessment to ensure the assessment covers all required aspects of a prospective person’s needs. A pre-admission assessment should be undertaken for all permanent prospective admissions, including those that already access the service as day care clients. Daily records, used to inform the care planning process must be detailed and note the care provided and any change to the person’s needs. The management and staff should ensure that a persons right to privacy and dignity is maintained at all times. The home’s activity programme should be reviewed to ensure that the activities provided are achievable and appropriate. The management should ensure that any risk of cross infection is minimised by the provision of hand washing facilities within the top floor communal toilet and within the staffs’ toilet. 2. 3 4 5 OP7 OP10 OP12 OP26 Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Holwell Villa DS0000018373.V348739.R01.S.doc Version 5.2 Page 41 - 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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