CARE HOMES FOR OLDER PEOPLE
Holwell Villa Holwell Villa 119 New Road Brixham Devon TQ5 8BY Lead Inspector
Judy Cooper Unannounced Inspection 20th December 2005 11:00 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.V264099.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V264099.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Holwell Villa Address Holwell Villa 119 New Road Brixham Devon TQ5 8BY 01803 854103 01803 859669 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.V264099.R01.S.doc Version 5.0 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 20th September 2005 Date of last inspection Brief Description of the Service: Holwell Villa offers accommodation with personal care to older people (60/65 ), older people with physical disability and older people with dementia. It is registered to provide a service for up to 17 service users both male and female. The manager also accepts day care service users (maximum of two, 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). In terms of communal space, Holwell Villa has a lounge and a dining room as well as a front garden and rear patio with seating. There are also communal bathrooms and toilets throughout the home, including a recently adapted walkin shower room. The building itself is a large detached property located within walking distance of Brixham town centre with its range of shops and amenities. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Tuesday, commencing at approximately 11.00a.m and finishing at 3.30p.m. Opportunity was taken to tour the premises, examine some records and policies and talk with the home’s owner (who was present for part of the inspection), the home’s registered manager, residents and staff. Staff on duty were also observed, whilst in the course of undertaking their daily duties. The majority of the required core standards were inspected at the last inspection in September 2005. Therefore those inspected on this occasion concentrated on resident welfare on a day to day basis, as well as looking at what progress had been made regarding the few shortfalls identified at the last inspection. The two core standards that had not been inspected at the previous inspection were also inspected on this occasion. What the service does well:
The manager continues to ensure that an “open door” policy is in place, which allows residents, staff and residents’ families/carers the ability to speak openly and easily, which helps all concerned deliver the appropriate care. A very relaxed, family atmosphere also continues to be maintained within the home, for which the manager and staff should be commended. The manager and staff continue to provide very individual care for the residents, some of whom are unable to communicate their needs. The manager and staff are aware of this and ensure care matches the residents’ needs and personal preferences as far as they are able to ascertain. The manager continues to maintain a regular “hands on” role within the home to ensure she is aware of the residents’ needs and is also aware of how the staff can best meet these needs. One of the home’s main strengths remains the way that the staff maintain residents’ dignity and their rights to make personal choices. Due to the category of the resident group cared for at Holwell Villa (i.e. many residents suffer from advanced dementia), it means that staff need to take time and use good observational skills to determine what a resident may be trying to
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 6 communicate, and this skill continues to be an integral part of the staffs’ role within the home. What has improved since the last inspection?
Increased staffing levels, have been provided in the late afternoon/evening and at weekends, to ensure that residents’ needs and welfare can be met and upheld. The registered manager now ensures that a full recruitment programme is in operation, which ensures that residents are fully protected by the appointment of suitable staff. Any radiator not yet guarded must be, to ensure that residents are protected form the risk of sustaining a burn from a hot surface. To protect residents from risks associated with window openings, the registered provider has undertaken a risk assessment of all of the homes’ windows and has installed window restrictors where any risk has been identified. Suitable privacy locks have been installed to the home’s communal toilet and bathing facilities. The owners have created an easily accessible bathing area in the form of a walk-in shower, for those residents who are physically less able. This has been seen as a very positive move within the home. The front driveway of the home is in the process of being extended to allow easier access off the main road. The manager and deputy manager of the home have achieved the Charted Institute of Environmental Health’s training certificate. This verifies that they are both up to the required standard to give in-house training in care related topics to others members of the home’s staff and so extend training options available, which in turn benefits residents by allowing staff to build on existing skills and explore new ones. The registered provider, manager and staff at the home have undertaken the in-depth work required to allow the home to be assessed for the “Investors in People” award. Work towards this award ensured the management and staff
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 7 were aware of their respective roles and further ensured that quality care is continually made available, which again ultimately benefits the residents by ensuring appropriate and skilfully managed care is provided. The assessment process took place in November this year and the home was successful in achieving the award. Well done!! What they could do better:
The registered provider must ensure that residents are protected from the risk of fire within the home by maintaining fire precautions in line with those recommended by the local fire and rescue service. (An immediate requirement was issued at this inspection in relation to two fire doors being noted as wedged open). The registered manager took immediate action and removed the wedges and this Commission has now been informed verbally that suitable “hold open” devices have been purchased and are in now place. The use of a stair gate has recently been implemented, at the bottom of the home’s main flight of stairs, to protect a resident who maybe at risk by attempting to climb the stairs unsupervised. Further thought should be given to utilising other means to protect this resident, which would then be less restricting to other residents. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 8 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. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 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.V264099.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The admission process continues to be appropriately managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: By looking at the records for one resident, who had recently been admitted to the home, it was noted that a full and detailed admission procedure was undertaken by an appropriately skilled and experienced staff member, which had ensured that Holwell Villa was an appropriate home for the resident. The home does not provide for intermediate care. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Residents’ heath and personal care needs continue to be well known, documented and met whilst residents are treated with dignity and respect and their individuality and independence maintained as much as is possible. The recent use of a stair gate, to protect one resident, could have the effect of inhibiting other residents’ movements. EVIDENCE: The care plan was seen which related to the resident whose admission procedure was previously inspected. The care plan was very concise and detailed and contained all relevant information appertaining to providing for the individual residents care, including any medical needs of the resident, as well as any visits made by District Nurses, G.P’s or any other health professionals. Care plans are regularly reviewed with the residents. The manager and staff liaise with other professionals as required including District Nurses, community psychiatric nurses etc. Those residents able to verbally feedback their feelings were very positive about the care received, saying that they felt well looked after and that the staff treated them well and were very kind to them. Others were seen to be
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 12 treated by the staff with kindness and due regard for the maintenance of their dignity and rights to individuality. To protect one resident the home has recently introduced the use of a stair gate at the bottom of the home’s main flight of stairs. This could also have the effect of inhibiting other more able residents movements. Discussion took place with the manager, following this inspection, who will look at the situation again to see if there is any more appropriate means that could be used. The manager also confirmed that she had sought advice from the local Devon Fore and Rescue service, in respect of their thoughts on the use of this device taking into account safe evacuation in the event of a fire. The manager advised that she would be following the advice given. Although the standard on medication was not inspected in full it was noted that medication administered during the inspection was done so appropriately and the manager confirmed that staff continue to receive medication training Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents continue to enjoy a varied, yet peaceful life at the home, with visitors encouraged and welcomed. Choices are made available to residents regarding day to day living and staff take time, and put in effort in, to ensure that all residents enjoy a good quality of life. The home continues to provide nutritious and varied meals. EVIDENCE: The home operates an open visiting policy and the visitor’s book showed that the residents continue to have many visitors at varying times throughout the day. Staff undertake activities with residents both individually and as a group on a daily basis. This can involve in house activities, which are changed regularly to meet the residents’ needs/desires each day, and, residents also benefit from being taken out on an individual basis to the local town or places of interest. On the day of inspection a bingo session was in operation with all those who wished to play being given the necessary support to allow them to fully participate. The home’s Christmas activity programme was seen to be full with appropriate activities, whilst the home was decorated very nicely.
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 14 Residents continue to be encouraged to express their individuality as far as possible and to this end one resident continues to have her pet cat with her and anther married couple their two cats and pet bird. Any resident that wishes to smoke is able to do so in a designated area of the home under staff supervision (if assessed as necessary). Religious needs are catered for well, with a different church visiting monthly to ensure all residents’ religious needs can be met. Current affairs are discussed, on a level that is appropriate, and daily newspapers are received by some residents. The home’s cook has been at the home for a number of years and is very familiar with the residents’ individual needs, likes and dislikes. It was noted that the meal served on the day of inspection was again to a high standard, presented well, being both appetising and hot and was enjoyed by residents. Any support required in helping with feeding is provided in a discreet manner and with due regard for other residents feelings. The routines within the home are very flexible to ensure that residents can choose how they spend their time. The majority residents had again chosen to spend their time in the homes’ communal lounges but a few others had chosen to spend their time in their rooms. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Although none of these standards were inspected, it should be noted that the home has not received any complaints, either internally or by the CSCI, since the last inspection undertaken in September this year. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Continued improvements/upgrading measures have helped ensure that Holwell Villa provides a comfortable, clean and warm environment. Residents’ safety was being compromising, by the management not fully maintaining all fire prevention measures within the home as required. EVIDENCE: Overall the home presented as very comfortable, clean, pleasant and welcoming. The tour of the building evidenced that the register provider continues to undertake any required routine upgrading within the home to ensure that a good standard of accommodation is provided throughout. Bedrooms have been personalised as desired and residents can bring in personal items with them if they wish to. The management of the home maintains the day to day home’s fire precautions in line with the requirements of the local fire department, however it was also noted that two doors were being wedged open during the
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 17 inspection. An immediate requirement notice was issued in respect of this, as resident safety is compromised by the use of such. The manager did take immediate remedial action before the inspection ended by removing the door wedges, and later confirmed that the registered provider had purchased suitable “hold open” devices to be used instead. Further recent upgrading has included the covering of two extra radiators within the home and the manager stated that window restrictors for windows on the second floor and first floor windows had now been fitted, and those inspected were in place. A walk in shower has now been created in the home from an existing bathroom, which was rarely used, and this change will allow those more physically dependent residents the ability to enjoy a shower with ease. The home remains clean with suitable infection control measures in place, which protects residents from the spread of any infections. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 Staff are employed in sufficient numbers to meet the current resident groups’ needs. Staff training provided, allows the staff the opportunity for further personal development and the ability to increase their skills and awareness in caring for the residents. EVIDENCE: Staffing levels were noted as being in sufficient numbers to ensure that residents’ needs could be met. Since the last inspection the staffing levels have been increased by one carer in the evenings throughout the week including weekends. Residents spoken again stated that they felt well looked after and that staff were “very kind”. Although the standard regarding staff recruitment was not inspected in detail the manager confirmed that enhanced C.R.B checks, have now been received for each member of staff. The manager and her deputy recently undertook a training course in supervision skills, to allow them both to be able to supervise the staff appropriately and effectively, thereby providing the necessary support to allow the staff to undertake their roles effectively. It was pleasing to note, that the staff mix continues to include two male carers, which helps keep a balance of a mixed gender staff group working within the home.
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 19 Training was again well planned and supports the staff in providing for the varied needs of the residents with statutory training and other work related courses being made available including NVQ training. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,38 The home continues to be managed efficiently and well with residents best interests upheld. Every day routine health and safety matters are well managed as required to ensure residents’ well being is maintained. EVIDENCE: The home continues to be well managed and the manager has completed her registered manager’s award and is waiting for verification of the award. The registered manager continues to improve the overall management of the home by ensuring all practices, policies and procedures, as well as the home’s records, are up to date and as required. The owner also spoke highly of the manager’s input into the running of the home. This input has resulted in an effectively run home, which ultimately benefits residents and staff. The registered provider and manager have undertaken the significant amount of work required to allow the home to be assessed for the “Investors in People”
Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 21 award, which took place in November this year and in which the home was successful. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 3 Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The registered provider must ensure that the homes’ fire precautions are maintained in accordance with the requirements of the local fire and rescue service. Timescale for action 20/12/05 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 OP10 Good Practice Recommendations The use of a stair gate has recently been implemented, at the bottom of the home’s main flight of stairs, to protect a resident who maybe at risk by attempting to climb the stairs unsupervised. Further thought should be given to utilising other means to protect this resident, which would then be less restricting to other residents. Holwell Villa DS0000018373.V264099.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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