Inspection on 20/08/08 for Holwell Villa

This inspection was carried out on 20th August 2008.

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

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

Other inspections for this house

Holwell Villa 11/10/07

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Holwell Villa Holwell Villa 119 New Road Brixham Devon TQ5 8BY Lead Inspector Rachel Proctor Key Unannounced Inspection 20th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holwell Villa DS0000018373.V370340.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.V370340.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.V370340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Females may be admitted from the age of 60 Date of last inspection 11/10/07 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 was held in the homes office and was available, on request, to any interested person as was stated in the home’s statement of purpose. Current weekly fees range from £326.00 to £390.00. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection, which took place over two days in August 2008. On the second day of the inspection an expert by experience assisted with the inspection. 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. During the visits a tour of the home was completed. People living at the home and staff were spoken to and some records were inspected. Seven of the people living at Holwell Villa had their care followed as part of this inspection. Their records of care were seen; the individual rooms they occupied were visited. The people whose care was followed were spoken to about their experience of care where this was possible. Visiting health professionals and social care professionals were also spoken to prior to the inspection. Information received from the home since the last inspection was reviewed, this included the AQAA (Annual Quality Assurance Assessment). Some of the comments made during the inspection have been incorporated into this inspection 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 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 Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 6 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? The home’s statement of purpose and home’s service user guide has been up dated and was provided for People who wanted it. This ensures that a prospective new person and or their representative are aware, prior to admission, exactly what facilities and services the home can provide. The care plans for each person have been rewritten and up dated to include detailed, relevant and in depth information in relation to their personal and social needs. Care plans are stored in one area in the home for easy reference. The manager has involved the people living in the home or their representatives in the development of their plan of care. This ensures that any care provided has been agreed with the person and or their representative and that all are happy with the care to be provided and with the manner it is to be delivered in. All care plans had been reviewed monthly or sooner if the person’s needs had changed. The home’s daily records contained details of the care required and given during each day and night in the form of an evaluation record and check list the manager had introduced since the last inspection. This enables all staff to be aware of any immediate changes to a person’s needs and provides information regarding what care to deliver to meet these. The privacy of people who live at the home has been improved by the provision of screening in shared rooms. This enables people in shared rooms to maintain their privacy and dignity when care is given. Risk assessment for the use of bed guards had been completed for those people who had been assessed as needing them. The involvement of the district nurse team, the person where possible and their representative had been recorded. These details were being kept in the individual person’s file. This ensures that restraint used was 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 has been reviewed to ensure that all peoples’ needs are being met and that activities being planed are both achievable and deliverable. The manager has sought the advise of the Alzheimer’s society regarding the type of activity programme to provide. A record of activities people had participated in has been recorded in individual plans of care. The response of the person to the activity they took part was also recorded. As a result of activities provided the manager recognised that people living at the home enjoyed stroking the rabbit brought in by one activity Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 7 organiser. She has bought a rabbit for the people at the home to enable them to see and stroke it whenever they wish. The complaints policy was easily available to the people and all other interested parties in the reception area of the home. The revised statement of purpose available in the entrance of the home also contains information for people about how to complain if they have any concerns. The communal lounge has been redecorated and new chairs provided for people. New white doors have been fitted to the toilet doors close to the lounge. The window on the landing has been fitted with restrictor to reduce the risk of injury for people living in the home. Since the last inspection the staff at the home have received dementia care training and the manager has made this training part of the core training staff complete. This enables staff to be 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 had been undertaken in a robust manner to ensure suitable people only are employed to work at the home. The required information had been provided in staff files. The manager has introduced regular supervision for all staff and was keeping records of the same. In addition to this staff receive an annual appraisal, which identifies their training and development plan. This ensures 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. The owners and registered manager have undertaken a formal quality audit of the service, which included seeking the views of the people who live at the home, their representatives and any other interested parties, including other professionals, that may have contact with the home. The results of the quality audit were available in the revised statement of Purpose provided in the reception area of the home. The management has produced an annual development plan for the home taking into account the feedback from the quality audit. This should ensure the home is always run in the best interests of the people who live there. The registered manager has completed the National Vocational Qualification in management at level 4. She was in the process of completing a further management award at a higher level. This should 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. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 9 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.V370340.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is good. People and their representatives are given sufficient information about the home and it’s services to make an informed choice about whether the home can meet their needs. The assessment process adopted by the manager should ensure that people’s health, personal and social care needs are fully assessed and their personal preferences and choices are taken into account. The home does not provide intermediate care This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the manager has up dated the statement of purpose and service users guide, a copy was provided for the Commission during the inspection. A copy was available in the reception area of the home. The manager advised that further copies would be provided on request. The statement of purpose includes a summary of the quality audit the manager had Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 11 completed and included some of the comments received from people living in the home and their relatives. The manager advised that the Statement of Purpose was a loose-leaf document, which could be up dated easily as changes occurred. One relative asked said they had been given information about the home before their relative moved in. They also said that the manager or her staff readily provided any information they asked for. The manager confirmed that the assessment process used in the home had been up dated since the last inspection. These were seen during the inspection in the seven peoples care plans whose care was followed. The assessment process includes information about the person’s health care needs. Risk assessments were an integral part of the care plans seen. Risk assessments for prevention of pressure sore, manual handling, nutrition and risk of falls had been completed in all those care plans viewed. These had been up dated monthly or when the persons needs had changed. In addition to these the manager caries out an assessment for mental health and mental capacity that identifies who is responsible for ensuring the persons needs are met. The manager advised that she had discussed these assessment with the Mental Capacity lead for Torbay who had given them advise on how to complete them. The mental health assessments show how the person’s mental health problems affect them and what actions staff should take to manage the person’s care. The manager had also completed risk assessments for the things that affected the individual person like anxiety, feeling cold or wandering. The actions staff should take to reduce the risk were clearly recorded. The seven people whose care was followed had assessments fully completed. Those that had care management assessments prior to their admission to the home had these with the homes care planning information. People had a plan of care, which had been developed, from their assessment of need. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is Good. The way peoples care plans are written should ensure that they receive the care they need. Care plans provide staff with sufficient information about the person to guide them how to provide their care. This means that people should have their care provided in a way they like and prefer. People receive the health care they need. The manager promotes and helps to maintain peoples health and ensures access to health care services. Medication practices are safe. People are treated with dignity and respect by the staff team who care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Seven people had their care followed as part of this inspection. This included looking at their plan of care seeing the rooms they occupied in the home and Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 13 meeting and speaking to them where possible. Staff were observed providing care for some of those whose care was followed. The plans of care seen provided information for staff regarding how to meet the individuals health, personal and social care needs. One person who presented with challenging behaviour because of their anxiety had a clear plan for staff to follow. An assessment from a consultant psychiatrist, which provided advice on how to best manage the persons anxiety was included with the care planning information. The care plan had been developed from this and guided staff how to respond when the person became anxious. The advice given included do not reassure, better to distract and change the topic, allocate staff time to spend with them on a regular basis. The care staff observed speaking to this person were doing so in a way that appeared to help them and reduce their anxiety. The manager advised that the person liked their meals at set times and became anxious if this was late. She also advised that the person had certain things that were really important to her that help to relieve stress. During the inspection the person had these items with them all the time. Staff was seen to be polite and friendly towards this person each time they asked the same question. Their plan of care also identified physical health needs, which included difficulty walking, the manual handling assessment indicated that the person could walk with the aid of a frame on good days and other days needed a hoist for transfers when their mobility deteriorated. The manager advised that both she and the deputy manager were manual handling assessors and trainers. During the inspection the person was able to stand and walk with assistance from staff. District nurses were involved to provide care for leg ulcers. Pain control medication had been prescribed for this person to take prior to their legs being redressed by the district nurses. The manager advised that she coordinated the time the medication was given with the time the district nurses were coming to ensure the person had good pain control. When this person was spoken to during the inspection they said the staff are very kind and look after me well. The district nurses visit the home on a regular basis to provide health care for people living at Holwell Villa who need this. One of the district nurses spoken to said they felt the care at Holwell Villa had improved since October 2007. Separate care plans were being kept in the home for the district nurse teams for individuals who were receiving their care. Four people who had been identified as at high risk of pressure sore development had hospital beds and air flow pressure-relieving mattresses provided by the district nurse teams to reduce this risk. The manager advised that one person whose care was followed who was spending more time in bed had been seen by the district nurse who had recommended bed rest to reduce the risk of developing pressure sore. The manager advised their position was altered regularly during the day while they were in bed to further reduce the risk. This information was clear in the care plan for staff. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 14 The manager has developed a daily dependency profile for each person living in the home. This was a checklist for staff to indicate when they have provided assistance with listed items. The list includes personal care tasks, continents, mobility, diet, fluid, mental capacity, mood and activities. The manager advised of the carer responsible for the person during a shift complete these. Each persons plan of care seen had a mental health and mental capacity assessment completed. These provided information about how the persons mental health problem affected them personally. A plan of care had been developed by the manager to ensure the person’s mental health care needs were provided for by the staff caring for them. This included the things the person liked and disliked. Two people whose care was followed had presented with some challenging behaviour, the plan of care guided staff how to manage the person behaviour. The manager advised that staff had completed training for dementia care. The manager confirmed she had completed a course for managing challenging behaviour and advised that this would be provided for staff at the home. Continents assessments had been completed in the seven care plans seen. These provided information for staff on the problems the person was experiencing and whether they needed continence aids to help them. One persons care plan recommended they were assisted to go to the toilet every two to three hours during the day or when they asked to reduce the risk of them being incontinent. The manager advised that she had sought the advice of the continence nurse assessment from the care trust regarding the management of peoples continents. During the inspection staff was seen assisting this person to go to the toilet. They were polite and always asked the person if they wanted help. The manager advised that the falls risk assessment was linked to the medication that people are taking. She commented that two people who wander at night did not have night sedation. She advised she had discussed this with the person GP. This was agreed to reduce the risk of the person falling when they wandered at night. The mediation records of the seven people whose care was followed were viewed. These had been completed and signed for each time medication was given. When a person had refused medication this was recorded. A senior member of staff was seen using the medicine trolley to take medication to the people who needed medication during the inspection. The medicine trolley was being stored in a locked room tethered to the wall. The manager advised that the treatment creams people needed for their skin were being stored in a locked cupboard in their individual rooms. These were seen during the tour of the home. The creams in two peoples rooms checked were prescribed for that person and with in date. The manager advised that if a person was able to self medicate the lockable cupboards in their room could Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 15 be used to store their medication. However the manager advised that none of the current people living at Holwell Villa had been assessed as able to self medicate safely. Controlled drugs were being stored and recorded as expected. Where medication had been returned to the pharmacy this had been recorded and signed by the member of staff completing the returns medication book. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. Holwell Villa was a lively home where people were encouraged to express their views and be themselves. People are involved and consulted about the activities provided for them and they can chose if they want to participate this should ensure that the activities provided meet peoples needs. People are given the opportunity to visit places of interest with in the local community if they are able. This should ensure people have the opportunity to mix with others in the community. People are given choices over how they spend their day. Staff encourage them to join in and participate in the things they have learned the people enjoy. This should ensure people could exercise choice and control over their lives for the things they are still able to do. The staff try to ensure that meal times are a pleasant experience for people living at Holwell Villa. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 17 On the second Day of the inspection an expert by experience accompanied the inspector. They were asked to focus attention on what it was like for people living at Holwell Villa, especially in regard to choices in getting up or going to bed, food, activities etc. They were particularly asked, through observation as some people did suffer from dementia, and discussion with people to find out how staff treated and interacted with people. And that due attention was paid to treating people with respect and was age appropriate. The expert by experience spoke with seven people two of whom had clear signs of dementia and were not able to provide verbal information of help to the purpose of inspection. Two people were still in their bedrooms, so expert by experience was able to talk to them in private. Other people were in the communal lounges and dining room. One relative who was visiting at the time of the inspection was spoken to. The expert by experience joined most of the people living at Holwell Villa at lunch and spent some time observing interaction with people and staff. No odours were notices throughout the building, which was furnished in a homely way. Carpets and soft furnishings were highly patterned in communal areas, which can contribute to falls for those with dementia. The bedrooms seen during both days of the inspection all had evidence of personal belongings. Two people said they were got up quite early that day, and when asked one if that was their choice they said ‘no I was woken up.’ Both these people said they came downstairs for breakfast. However all other people spoken to said they got up when they wanted, were brought a cup of tea, and had breakfast in their own rooms. When this was raised with the manager she assured us that often people are up and wandering around, in which case they are helped to wash and dress. The manager confirmed that none are called against their choice. There was a choice of alternatives at lunch and tea, all of which are displayed on a notice board in the dining room. The manager advised that people were asked each day what they would like. This was observed to be the case both days of the inspection. One person said there were a few main courses they did not like and that they were only offered a baked potato as an alternative which they also did not like. The manager said she did not think this was always the case but would note it on their care plan. Most people agreed that they enjoyed the food which had a good supply of fresh vegetables, although one said the food was ‘a bit like we used to have in the NAAFI’ (This person did have a degree of dementia) Certainly on the day lunch was observed most people completed their meals, said they enjoyed them, and one was offered extra. One person had gained the role of laying tables for lunch. They told the inspector that they took pride in making the tables look nice for the meal. It was observed that they sometimes became quite irritated particularly with those people with dementia who had not finished their meals in time or who Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 18 did not eat their food. This person would take advantage of times when staff were not in the room to get up and try and make one person eat or to fill up glasses with drink, and thereby inadvertently giving people with diabetes the wrong drink. This was raised this with the manager who said she would try and ensure that one member of staff stayed in the dining room at all times. Three people all with dementia were served at a first sitting. The manager advised that this was because other people had complained about the mess they made and that they sometimes took food from other people’s plates. By giving them their food first everyone was able to enjoy a relaxed atmosphere. Two of these people were helped to eat by separate, consistent members of staff who sat alongside them throughout the meal, mostly talking to them explaining what they were eating etc. The manager had advised that one person prefers to eat on their own. She further commented that they had found that they became self-conscious if they were given their meal in a crowded dining room and had often not eaten their food. A programme of activities was displayed on a notice board following a themed pattern each week, e.g. exercise, use of senses, music, etc. There was also a programme of trips out displayed, which happen about twice a month. This was accompanied with photographic evidence of passed trips. All the people spoken to confirmed that there was always something going on and that they joined in the activities they wanted to. One said ‘I do as much as I want’ and another said ‘I join in what I like but I don’t go on the trips.’ One person who needs to use a wheelchair said ‘I ‘m not able to go on the trip today, but I went on the last one and will go on the next one. Three people spoken to confirmed that staff treat them with dignity and ensure privacy when carrying out personal care tasks. One person said they preferred to stay mostly in their room. The manager advised that staff did go up to talk with they which they enjoyed, and that they came down for lunch. Staff were observed offering choices and explanations when they were going to carry out an action with a person e.g. ‘would you like to go in to the lounge’ and I’m going to push you now’. Throughout my time in the Home staff were constantly chatting with people, and bantering with each other. There was a warm, homely ‘buzz’ in the communal rooms downstairs and in the kitchen, with a lot of interaction between people living in the home and with staff. With one exception everyone spoken with, even those with dementia, chatted happily to the expert by experience and at length, indicating they were used to doing so. It was noticed that some staff were using terms of endearment e.g. ‘lovie’ and ‘my dear’, and one staff giving a person a kiss on the cheek. This was raised with the manager as it can be interpreted as disrespectful and not good practice. The inspector and the expert by experience were reassured when the manager advised that she would try and be aware of it. However neither the expert by experience or the inspector would want to see the warmth of interaction lost. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 19 Even when staff were bantering with each other people were involved and seemed to enjoy the liveliness of the staff. All the people and the one relative spoken with confirmed that they thought the staff were very good. Whilst there was evidence of the use of endearments all of the people and one relative were happy with the care given in the Home. The expert by experience commented that they had not observed such a lively home for some time Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. People are given information about how to complain if they have any concerns and they can have confidence that any concerns they have will be dealt with sensitively by the staff team caring for them. Staff have received training for the protection of vulnerable adults and their recruitment has ensured that people are protected from unsuitable staff. This should ensure people are in safe hands. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has received one anonymous complaint since the last inspection. This was not substantiated at the inspection. The complaints policy was displayed in the hallway of the home. One relative spoken to said if they had any concerns they were always dealt with promptly by staff. They said they had confidence in the staff and felt any concerns they had would be dealt with to their satisfaction. They further commented that they did not have any complaints about the home or the staff team and were very happy with the care and attention their relative was getting. The manager advised that she had not received any complaints about the home since our last inspection. She further commented that any grumbles are dealt with straight away and people have been satisfied with the actions taken. However a record of these was not being kept on the first day of the Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 21 inspection. On the second day of the inspection the manager had started a complaints, grumbles and compliments book. A compliment received from the district nurse team had been recorded in the book. Recruitment practices protect people form unsuitable staff. The manager confirmed that staff have received training for the protection of vulnerable adults. The staff spoken to during the inspection were aware of how to raise concerns and what actions they should take if they suspected abuse had taken place. The manager advised that staff have policies and procedures available to them for the protection of vulnerable adults and a whistle blowing policy. Staff confirmed that these were provided for them. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 22 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): 19,26. Quality in this outcome area is good. People live in a pleasant reasonably decorated and maintained home, which is kept free from odour. When the planned improvements to the homes environment have been completed in all the areas identified in their improvement plan it will improve the overall look of the home for the people who live and work there. Staff have received training in infection control and were observed to have good infection control practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour for the home was completed with the manager as part of this inspection. All the communal areas and the rooms people were occupying were seen. The home was fresh smelling, the manager advised that an odour control system had been fitted, which provided automatic air fresher in communal rooms and corridors. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 23 People’s rooms had been personalised with items of their choice. This included picture of family ornaments and small items of furniture. The manager advised that the district nurse team had organised hospital style beds for people who needed them. These were seen in two shared rooms. The beds were easily height adjustable and easily moveable. All four had air flow pressure relief mattresses fitted to them. The en-suite bathroom for room 18 had been cleared of furniture and bric-abrac that did not belong to either of the two people who share this room. The carpet strip between the en-suite bathroom and bedroom area of this room had been secured. The manager confirmed that the lighting had been changed in communal areas to make it brighter. The doors to the toilets close to the lounge had been changed to white making them brighter in appearance. The shared rooms in use had sufficient easy chairs for people visiting to sit. One room had two chairs and a small table. The manager advised that the person liked to sit with their relative and have a cup of tea or something to eat. The way the chairs and small table were placed enabled them to do this. The carpet in one person’s room was stained. The manager advised that this was cleaned daily but the stain would not come out. The domestic advised that the home has a carpet shampooer, which is used if there are any spills or stains on the carpet. The carpet in another person’s room was in the process of being changed during the inspection. One persons room entered had the window covered below head height. There was still natural light entering the room but the person would be unable to see out of the window when seated or in bed. The manager advised that the reasons for the window being covered were clearly explained in the person’s assessment, which had involved their family. The manager said she had spoken with the persons care manager and GP about he window since our last inspection. During the inspection this person was using the communal areas in the home walking freely between them. One staff toilet next to the laundry and a toilet on the first floor used by people living on that floor did not have a hand washbasin provided with in the toilet. This means that people have to use a washbasin in a different room to wash their hands. This could be an infection risk. However the manager had provided hand sanitise gel in the toilets with out washbasins for people to use. Toilets and bathrooms in the home had a paper towel roll for people to use stored on a shelf. By not providing a holder for the paper towel it could be an infection control risk, if people had not washed their hands properly or the paper towel fell on the floor. In order to reduce the risk of infection the Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 24 manager should consider placing the paper towel in communal bathrooms and toilets in a holder. A raised strip was still in place in the walk-in shower to stop water drainage onto the carpet outside the shower. 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. This was noted at our last inspection. The manager advised that the strip had not a caused a problem for the people using the bathroom since the last inspection. And people using the bathroom had been risk assessed. The window restrictor had been fitted to the landing window of the home. This was noted as a risk for people at the last inspection. The inside of a double glazed units on the back stairway, which was noted as being very dirty at our last inspection had been cleaned. The manager confirmed that a new washing machine had been purchased since the last inspection. The owner was in the process of decorating the laundry room. He advised that new flooring would be fitted when the painting had finished. Staff had access to gloves and aprons for providing personal care these were being used during the inspection. The manager provided an infection control policy for staff, which was easily available. She also confirmed that staff had received infection control training from a health protection infection control nurse. The manager provided the homes development plan for inspection. This showed that repairs and renewals to the environment were due to take place over the next twelve months. The owner confirmed that the individual people’s rooms and communal areas were being decorated on a rotational basis or when the room became vacant. The manager advised that the lounge had been repainted and the radiator covered. New chairs for the lounge had also been provided. And new white doors were due to be fitted to the toilet door close to the lounge. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 25 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 good. The staff team at Holwell Villa are committed to improving people’s experience of care. The manager employs sufficient staff to ensure people have staff available to them. The management of the home are committed to ensuring staff have the training to care for the people living at Holwell Villa. The training provided for staff has increased to include dementia care as a mandatory topic. This should ensure that staff have the knowledge and skills to care for people with dementia. The recruitment practices are safe and should protect people form unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided a copy of the duty rota, which showed how many staff were on duty and in what capacity they were employed each day. The rota showed that more people were on duty for the morning shift. The four staff spoken to during the inspection said there were sufficient staff on duty to allow them to complete their work and have time to speak to the people living at the home. The manager advised that since the last inspection two waking night staff are employed. She confirmed that this has been put in place because of the increased dependency of the people living at a Holwell Villa. The rota Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 26 showed that in addition to care staff the home employs a cook, assistant cook and housekeeper. During the inspection the owner was completing maintenance tasks. The AQAA (Annual Quality Assurance Assessment) provided by the manager stated that “All new staff that have not already achieved an NVQ at level 2 are required to complete induction training within the first 12 weeks of their employment, these are training books that incorporate the Common Induction Standards to meet the General Social Care Council codes of practice.” Staff spoken to during the inspection confirmed they had access to training and had regular up dates for fire, manual handling and health and safety. The information also stated that six of the nine care staff employed had achieved an NVQ level 2 or above. This exceeds the standard of 50 of care staff achieving NVQ level 2. The manager confirmed that the home was staffed with out the use of agency staff as the existing staff covered shift shortfalls between them. The manager advised that four staff had left at the same time at the end of July beginning of August and this had caused some problems covering shifts. She confirmed that new staff had started or were waiting to start pending satisfactory employment checks. One of the new staff was working at the home during the inspection. They confirmed that they had a police check before they started work at the home and had been asked for references. They also said they had received manual handling and fire training since they started work at the home and had other training days planned. This staff member staff file contained the pre employment checks expected. The staff team on duty both days of the inspection were working well together. Two staff who had been at the home prior to the staff leaving in July said the new staff were settling in well and the home had a stronger staff team. The manager confirmed that the home was a happier place to work as staff were working well with each other. Three staff files were seen during the inspection. The manager advised that one person had been employed through an agency and the agency carried out pre-employment checks. However a copy of the staff member’s references were not being kept on file. A copy of the staff member’s visa and their police check were provided. The other two staff files viewed had a copy of two references on file. They had both had police checks completed. A photograph of the staff was not provided with their staff file. The manager advised that she intended to make a display board to enable people at the home to see the names of the staff on duty with their pictures. The training staff had received and had planed demonstrated that the manager was committed to ensuring staff have the knowledge and skills to care for people. Recent training included Mental Capacity Act, managing challenging Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 27 behaviour and dementia care. The manager confirmed that all new staff would be undertaking this training as soon as courses became available for them. All four staff spoken to said they had access to training that helped them do their work. The manager had used information provided by the Alzheimer’s society to improve the activities provided for people in the home. The information she received was available for staff to use. The staff observed caring for people were friendly and supportive answering the same questions they had been asked a few minutes before calmly and respectfully. Staff were seen to explain to people what they were doing before they did it keeping them involved with what was going on. The staff appeared to be skilled at caring for people who had dementia. The manager provided an example of the induction programme used for all new staff. The new member of staff spoken to said they had received an induction when they started work at the home. The manager stated in the AQAA (Annual Quality Assurance Assessment) “Inhouse training was provided on a four weekly basis covering many topics and updates. These are held in groups of 4 staff to allow maximise the input and receipt of information. The Manager and the Deputy Manager have received training as Moving and Handling trainers and are now qualified to deliver this training to all staff.” Copies of certificates for courses completed by staff were available. A list of the training planed for the year was displayed on the notice board. This covered a different topic each month. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. The service benefits from having a consistent manager who was approachable and well thought of. The home manager tries to ensure that Holwell Villa was run in the best interests of the people who live at there. This means that people’s individuality was respected and promoted by the management systems in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that she had completed an NVQ level 4 in management and was in the process of completing a further management award. The manager has several years experience of managing the care home. A newly appointed deputy manager who was previously a senior carer supports her. They had taken responsibility for some of the management Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 29 tasks in the home. The information provided during the inspection regarding the training the manager and her deputy have undertaken since the last inspection shows that they are committed to keeping them selves up to date with best practice. The manager provided a copy of the quality assurance assessment and the home development plan. This provided information regarding what has improved and what improvements were planed for the next 12 months. The results of a survey of people living at the home and their representative were included in the Quality Audit. The results of this were available for the people living at the home in the revised statement of purpose. This showed that people living at Holwell Villa are consulted and informed about changes that affect them. The manager provided a list of the policies provided at the home. These had been reviewed recently. The manager confirmed that staff are told about any changes to the policies in the home. Staff spoken to said they knew where the policies for the home were. The Requirement and Recommendation from the last report have almost all been met with in the time scales. The improvements to the environment included the issues raised at our last inspection. Plans to complete the outstanding Requirement for the environment were in place. The manager advised that none of the current people living in the home are fully able to manage their own finances as they lack capacity. Assessments were seen in the seven individual peoples care plans. The manager advised that she keeps a separate record of expenditure for each person and any money held on their behalf was stored securely. She also confirmed that each person had a separate folder for the money they had and receipts of expenditure and money received were being kept with these. The manager stated that people living in the home have advocates such as family member or solicitors who manage their affairs for them and the home dose not mange any of the current peoples finances. Staff spoken to during the inspection said they had regular discussions with the manager about their work. A record of supervision completed with the staff was being kept. Supervision included aspects of practice and career development for the staff member. The manager provided examples of the appraisals and supervision records being kept for staff. This shows that staff are encouraged and support to develop their skills and abilities through training. The manager and deputy are accredited manual handling trainers. The training programme for August included manual handling up dates for all staff. Staff spoken to confirmed they had had manual handling training or were due to do it later that month. Staff observed moving people using a hoist were Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 30 doing so safely using hoists and other equipment provided at the home. Staff were explaining to people what they were doing through out the lifting and handling process. A written statement of the policy, organisation and arrangements for maintaining safe working practices was in place. Risk assessments for individuals living in the home were an integral part of the care planning process. The manager reports any untoward incidents or injury to the Commission through notifications. A record of accidents and incidents was being kept at the home, which showed the actions taken by staff at the time. Records of fire safety equipment checks and staff instruction for fire were being kept. Staff confirmed they had received fire instruction from an external trainer recently. Induction was being completed for all new staff who joined the staff team. One new member of staff spoken to said they had started their induction and had worked with the manager and other senior staff. The security of the home was satisfactory with a keypad system being in situ at the front door of the home. To exit the home it was 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.V370340.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP7 OP19 Good Practice Recommendations The manager should ensure that the person’s preferred name is recorded in their plan of care The owners/management should continue to 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 in the home live in a comfortable, pleasant environment which meets their needs. Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 33 3. OP26 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 staff’s toilet. The management should ensure that any risk of cross infection is minimised by the considering provision paper towel dispenser in bathrooms and toilets used by more than one person The manager should ensure that recent photographs of staff are provided. As per Schedule 2(1). 4 OP29 Holwell Villa DS0000018373.V370340.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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