Inspection on 22/11/07 for Holyrood House

This inspection was carried out on 22nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Holyrood House 22/01/09

Holyrood House 21/06/07

Holyrood House 06/07/06

Holyrood House 20/12/05

Holyrood House 17/08/05

Holyrood House 10/03/05

Holyrood House 13/01/05

Holyrood House 20/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holyrood House 46 Green Lane Ostend Burnham On Crouch, Maldon Essex CM0 8PU Lead Inspector Alan Thompson Unannounced Inspection 22nd November 2007 11:15 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 Holyrood House DS0000017852.V355355.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. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holyrood House Address 46 Green Lane Ostend Burnham On Crouch, Maldon Essex CM0 8PU 01621 784759 01621 784856 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 Peter Walters Mrs Melanie Walters Mrs Melanie Walters Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2007 Brief Description of the Service: Holyrood House is a detached property that was first registered as a private care home for three older people in 1994. The owners are Peter and Melanie Walters, who is also the registered manager. This home is situated on the outskirts of Burnham on Crouch but is not within walking distance of the towns facilities. Holyrood House caters for three older people in a homely environment, which they share with the owners. As a family home, residents are able to receive consistent day-to-day care and involvement with the owners and a small team of care staff. Residents’ private accommodation is in single bedrooms on the ground floor. Access to the rear garden via patio doors would be difficult for wheelchair users. Adequate car parking facilities are available at the side of the property. As at 21 June 2007, the manager advised that the fees for accommodation ranged from £420 to £450 per week. Items considered to be extra to the fees include private chiropody (£35.00 at the time of inspection), hairdressing, toiletries and newspapers. CSCI inspection reports are available from the home and the CSCI website. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took into consideration all the information the Commission had received about the home since the last inspection, including the Annual Quality Assurance Assessment (AQAA), completed by the manager for the Commission and surveys, completed by 2 people living at the home (with the support of people working there), one staff member and a visitor. The site visit, lasting 5.25 hours took place on 22 November 2007 and involved speaking with people living and working at the home, as well as the owners and registered manager and a regular professional visitor to the home. It also entailed a partial tour of premises, observation of care practice and the sampling of records. What the service does well: • People living at Holyrood House have been there for a number of years and benefit from a small-scale, family style home and the continuity provided by the manager/owners who live on the premises and a small, flexible team of staff, who know them well and spend time talking and listening to them. People thinking about coming to live at the home would have an assessment of their needs to determine whether it could offer the required care and support. People could expect their healthcare needs to be appropriately monitored and addressed. People could expect their individual needs and lifestyle preferences to be respected. A visitor wrote in their survey that the home ‘treats all residents as people, not numbers. Finds out their particular likes and dislikes. If any resident expresses a wish for anything, if they don’t have it, they will get it’. • • • What has improved since the last inspection? • Care plans had been developed and now provided detailed guidance to staff about how to care for each person, promoting their individuality, choice and independence. Records of care were being maintained for each person on a daily basis to show how the home was meeting their needs. A complaints record had been introduced to show how issues people raised were being addressed and monitored. DS0000017852.V355355.R01.S.doc Version 5.2 Page 6 • • Holyrood House • • • The confidentiality of records had been improved by the introduction of a lockable filing cabinet. The home was keeping a record of people visiting to safeguard everyone living there. The home’s certificate of registration had been moved to a place, where it could be seen by residents and people visiting the home, with both pages to view, as required. All the issues, identified at the last inspection in connection with the safety of the environment, had been addressed. This included complying with requirements issued by the Fire Authority and safety checks on gas, electricity and hoist. The bathroom had been retiled and painted and the home was clean and fresh. • • What they could do better: • People living at the home and prospective residents need up to date written information about the service they can expect from Holyrood House and how to make a complaint (Service User Guide). Monthly evaluations of care plans should be documented in a way that shows individual progress in relation to the plan. It is not always sufficient to give a date without any comment. To minimise the risk of error, people administering medication must follow correct procedures. The registered persons must follow all the required procedures for recruiting and selecting staff so that people living at the home are protected from anyone, who might not be suitable to work with them. • • • 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. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 7 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 Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 8 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, 2 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People thinking about coming to live at the home could expect to have an assessment of their needs to determine whether Holyrood House could offer the required care and support, but not to have up to date written information about the home. EVIDENCE: The Statement of Purpose and Service User Guide, containing the complaints procedure had not been updated since 2003. It still referred to the Commission by its old name. Details of staff were also out of date. One person living at the home did not think they had any information about the home in the form of a Service User Guide. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 9 A new person had taken up residence in February 2007. Although this person had for many years lived at Holyrood House under a different arrangement, an assessment of need was completed prior to their admission to the home. Both the manager and the person concerned had known what to expect from the new arrangement and this had made for a seamless transition. National Minimum Standard 6 did not apply to Holyrood House at the time of inspection. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could expect their health and social care needs to be met according to an individual plan but not to be fully protected by the procedures for administering and recording their medication. EVIDENCE: Records were inspected for all 3 people living at the home. Re-assessments of their needs in July or August this year, incorporated social histories and personal profiles to enable people working at the home to support them individually, in the most appropriate and meaningful ways. Each person had an individual care plan, based on the assessment, and full of detail about how they liked to be cared for day and night. The care plans included guidance to staff about what individuals could manage independently (such as cleaning teeth and using a mouthwash), aids and equipment to use Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 11 (beaker, cutlery, a pressure cushion) individual characteristics that staff needed to take account of (‘likes to wear perfume’) and personal preferences in respect of daily routines like getting up/going to bed and meals (‘likes the same breakfast every day but still ask’). Individual progress records, though brief, were now being maintained on a daily basis to show how the home was meeting people’s needs. The manager had also introduced monthly evaluations since the last inspection, although records of these were limited to a series of dates in the margin of the care plan and did not provide any comment. Information held on individual files included a medical history and contacts with medical professionals. Individual care plans showed how risks to individual health, such as malnutrition, pressure sores and poor circulation were being managed. The manager stated in the AQAA that the home had a good rapport with local GPs and district nurses and it was evident from records and discussions that there was a high level of input from medical professionals. People living at the home indicated in discussion and/or their surveys that they always got the medical support they needed. Current Medication Administration Records, starting on 12/11/07, were inspected for all 3 people living at the home. For one person 8 gaps in recording were noted between breakfast time on 20/11/07 and supper on 21/11/07. This person said they knew the medication they were meant to have and had been receiving it. There were 2 gaps for another person at teatime on 21/11/07. For the third person, there were gaps in respect of a breakfast time medication on 15/11/07, 17/11/07 and continuing and, on 20/11/07, a gap at breakfast time for another medication. Although the manager attributed these omissions to a member of staff who was leaving in 2 weeks, it is the manager’s responsibility to ensure that people administering medication are able to do so competently. There were no records to show that this person had received training in the administration and recording of medication. The home was using for reference the Royal Pharmaceutical Society of Great Britain’s medication guidelines 2003; the in house medication policy was not dated. Medication training for the other member of staff had been arranged to take place on 7/12/07. They said they had previously had training but not obtained a certificate, having missed the last part of the course on administering eye drops. They were observed administering people’s lunchtime medication from separate packets and recording this on Medication Administration Records. They signed the record before giving the medication, saying that the people living at the home had never been known to refuse it. Each person’s current Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 12 medication was kept in a separate plastic box with a lid, inside a locked wall cupboard. There were no excess stocks. People living at the home had en suite facilities for privacy. The manager indicated in the AQAA that the small scale of the home meant that staff had time to meet people’s personal care needs without rushing them. This was also evident from the detail of individual care plans. Discussion with a person who needed 2 people to assist them with some aspects of personal care showed that they did not feel they had to wait unduly for the help they needed and that they felt comfortable with the way it was given. Following comment at the last inspection about the use of plastic duvet, pillow and mattress covers for one of the residents, which did not appear to promote their comfort and dignity, the manager indicated that the person wanted these to remain in place. It was not possible to confirm this with the person concerned. It was evident from observation and records that people had their own toiletries; there were none for shared use in the bathroom, as at the previous inspection. A notice in one of the bedrooms, giving instructions to staff for managing an aspect of occupant’s care, did not promote this person’s privacy and dignity. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Holyrood House benefited from the informality and small scale of a family home and a lifestyle, which mainly suited their needs and preferences. EVIDENCE: Discussion with one person living at the home showed that their choice to remain in their room was respected. It was evident from talking with staff that people could get up and go to bed when they were ready. One person remained in bed until 10:00 am on the day of inspection. The manager and staff indicated that people currently living in the home were not interested in ‘activities’. One person, responding to the Commission’s survey, indicated that there were no activities they could take part in and the other commented, ‘I don’t like activities because I can’t do anything and don’t really want to’. One person said that they were content to watch television in their room, following the programme schedule that the manager gave them Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 14 each week. They also had magazines to hand. It was observed that two others, one very frail, sat without any occupation. Staff reported that people enjoyed the hairdresser’s visit and staff painting their nails but otherwise preferred to sit quietly. Care plans covered individual lifestyle. One contained evidence that family had been consulted about suitable stimulation, listed favourite television programmes and instructed staff to provide stimulation by talking with the person as much as possible and encouraging their participation in care. People working in the home did spend time talking with residents during the inspection. One person’s daily records showed that staff tried to encourage them to socialise and talk. As one member of staff wrote in their survey, about things the home did well, ‘We give all of our residents lots of one on one interaction’. Information sent to the Commission (AQAA) advised that people could have what they liked to eat and the home bought and prepared food that they fancied. A visitor wrote in their survey that the home, ‘Treats all residents as people, not numbers, finds out their particular likes and dislikes. If any resident expresses a wish for anything, and (the people in charge) don’t have it, they will get it’. All food is homemade, including cakes and puddings’. Records showed that choice was available and individual preferences respected at breakfast and teatime. Recent tea menus (mainly sandwich and /or cakes and buns) had not included fruit, vegetables or salad. Lunch, on the other hand was a balanced meal, partly cooked from basic ingredients and including a green vegetable. People said they enjoyed this. Respondents to the survey said they always liked their meals. It was noted that tea was served before 17:00 pm on this occasion. As one person had not had breakfast until 10:00 am that day, they had 3 main meals in 7 hours, not really allowing sufficient time to develop an appetite and creating a possibly long wait between the last meal of the day and breakfast. The dining room continued not to be used for meals, which were served to people in their armchairs. This meant that people did not benefit from a change of scene or position and lacked the exercise that moving to a table or changing position involved. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The owners have taken seriously the views of people living at the home but people cannot be assured of knowing how to raise concerns and staff may not be fully informed as to how to deal with abuse. EVIDENCE: People living at the home did not have a copy of the complaints procedure, and some of the details it contained were out of date. However, the manager had introduced a complaints log since the last inspection and this contained two entries, one of a complaint made in August 2007 about limited options available for breakfast and, one made in November, about staff sitting down and not working. Both these were from a person living at the home. In both cases the manager was able to provide suitable explanation and reassurance for the complainant and this was recorded and the complaints not upheld. Surveys completed by people living at the home, with the help of the manager or staff, indicated that they felt listened to. A member of staff, describing what they thought the home did well, wrote, ‘We always listen to the residents and deal with their requests as quickly as possible’. Both people living at the home, who returned surveys, said they knew who to speak to, if they were not Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 16 happy; one said they knew how to make a complaint, the other that they had no complaints. Discussions with the manager and people living at the home supported information in the AQAA that an advocate was available to represent the interests of anyone in the home who requested a visit, although the person did not visit on a regular basis. A person who had been visiting the home for a number of years in a professional capacity expressed confidence in the way individuals were cared for and the caring attitude of staff. They particularly commended staff for their manner with people living at the home and the way they talked with them. Both providers had attended protection of vulnerable adults training provided by Essex Social Services and a copy of the guidance and procedures issued at that time was used as reference by the home. The manager had not developed a policy and procedures specifically for the home. She said she would access new local guidance on ‘safeguarding adults’ and ensure that everyone working in the home was made fully aware of it. The home’s AQAA indicated that Safeguarding Adults training was planned for staff. CSCI considers that, despite the evidence that people living at the home were well treated generally, they had been placed at some risk by the home’s recruitment and medication administration practices. These matters have been addressed under separate headings in this report. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 17 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, 21, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to the environment meant that people were benefiting from a home that was clean, safe and suited to their needs. EVIDENCE: The home’s record of work in hand or completed showed that, since the last inspection, the bathroom had been refurbished with new ceiling and wall tiles, the hoist and gas serviced and electricity installations checked. Since the last inspection the home had complied with requirements issued by the Fire Authority, which it had been previously not addressed: Both fire exits had been illuminated and an automatic closure fitted to the kitchen door. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 18 . Radiators were covered to protect people from hot surfaces. En suite facilities were well equipped to promote mobility. A large handwritten notice was displayed in one of the bedrooms with instructions to staff about managing the particular needs of the occupant. This was not homely and did not promote the person’s dignity. The lack of carpet and plastic under-covers on the duvet and mattress also made this room feel less than homely. Information sent to the Commission (AQAA) showed that the registered persons planned to continue improving the environment by redecorating the lounge and bedrooms, upgrading the en-suites and re-carpeting communal areas. All areas inspected were fresh and clean. A marked improvement was noted in the cleanliness and tidiness of one of the bedrooms. Laundry facilities had not changed since the last inspection but were scheduled for refurbishment. Liquid anti-bacterial hand-wash was available in the bathroom and paper towels (from new dispensers) were in use throughout the home for the control of infection. Records showed that both staff had attended a half-day course on infection control on 7/11/07. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 19 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, 2, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home benefited from flexible staffing arrangements but were not fully protected by the home’s recruitment and training practices. EVIDENCE: The manager confirmed information provided in the home’s AQAA that their 2 staff usually worked 47 hours per week between them but could be flexible. The roster was held on computer and staff had to log the hours they worked in order to get paid. This log was the home’s record of actual hours worked. Staffing arrangements were discussed with the manager, staff on duty and a person living at the home. The manager said that, despite having only 2 part time staff, she and her husband had been able to take holidays. During a recent holiday one member of staff had been able to live in and they used a domiciliary care agency for additional cover. The manager said that their adult children also lived at home and could provide support in an emergency as they had grown up with the residents. For example, one had attended a course on food hygiene (certificate seen and up to date) so they could help out with meals and regularly prepared tea. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 20 Information contained in the AQAA stated that the home was staffed according to individual needs. A member of staff on duty said they could be very flexible and come to work at short notice. For example, they had extended their shift on the afternoon of the inspection to accommodate different things that were happening. They said that the staffing arrangements ran smoothly and there were always 2 people available to assist individuals with transfers when this was necessary, mainly mornings and evenings. They said that it was rare for them to be the only person in the house and this would only be for a short period. They also mentioned the owner’s adult children being around to help with non-caring tasks, although they acknowledged that on rare occasions, they had called on them to assist with transfers. The member of staff who completed a survey (possibly the same person) said there were always enough staff to meet the needs of people living at the home. Of the 2 people living at the home, who responded to the Commission’s survey, 1 said that staff were always available when they needed them and that they ‘always’ received the care and support they needed, the other answered ‘usually’ to both questions. One person living at the home said that the manager’s husband (registered provider) would assist with transfers but not with personal hygiene. They said they usually did not wait long if they needed assistance to transfer and one person could manage to support them because they were just weight bearing. Recruitment records were inspected for the two people working at the home, who were not part of the family living in. Their application forms did not include full working histories with dates, which are required so that any gaps in employment can be fully explored. One person had started working at the home with a Criminal Records Bureau (CRB) disclosure, obtained by a domiciliary care agency, for which they were also working at the time. There were no written references, only a brief note about a phone call to obtain a verbal reference from their employer. The other member of staff similarly had only provided a verbal reference. The manager explained that both staff had come to work at Holyrood by invitation; she had known one since they were 5 years old; the other had been coming to the home for 2 years from a domiciliary care agency, to support an elderly relative of the owner (not a resident of the care home). Following a requirement made at the last inspection, the manager obtained enhanced CRB disclosures for both members of staff. She was advised that all the documentation required by regulation must be obtained for anyone working at the home, or providing support to people living at the home, including family members. Records showed that the home’s induction training involved staff in a number of familiarisation tasks, listed on a single sheet of paper, including introductions, use of call system, fire safety arrangements, daily routines, record keeping, health and safety and the philosophy of care. The member of staff present for this inspection, who was an experienced carer, said that working alongside the manager had prepared them well for the work they were Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 21 required to do, especially as they had been familiar with the home and people living there as a result of caring for a relative of the owners for 2 years. Records showed that the other member of staff had undergone a similar induction. The manager was advised that new staff should be undertaking the Skills for Care induction programme, which is portable and ensures staff in all care settings have sufficient grounding for their work. Records, and discussions with the owners and staff, showed that everyone had undertaken training in the past 12 months. All 4 had completed a half-day course on infection control; both owners had attended protection of vulnerable adults training (since superseded by Safeguarding Adults training) one had completed medication training and, the manager, the National Vocational Qualification (NVQ) Level 4 in care and the Registered Manager’s Award. Medication training had been booked for the staff member who was staying on at Holyrood House, and a response to an application for the same person to commence training for the recognised qualification in care, NVQ Level 2, was awaited. This person had also attended moving and handling training and a course on Parkinson’s Disease within the past year, but with their previous employer. It was evident that the person responsible for the missing entries in the Medication Administration Records needed to attend relevant training. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The safety and welfare of people living and working at the home was being promoted by a more systematic approach to health and safety and quality monitoring. EVIDENCE: Certificates were available to evidence that the manager had achieved the National Vocational Qualification (NVQ) in care, Level 4 and the Registered Manager’s Award. She said that she was awaiting a response to her application to do the NVQ assessors course, which would equip her to facilitate staff to achieve Level 2. Discussion with a member of staff, and a survey that Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 23 was returned by staff, indicated that they had good working relationships with the manager. As the owners lived on site and provided most of the care themselves, they were continuously involved in the lives of people living at Holyrood and had detailed knowledge of their individual needs and circumstances. Since the last inspection, the manager had moved the home’s certificate of registration to a place, where it could be seen by residents and people visiting the home, with both pages to view, as required. The home sent us their Annual Quality Assurance Assessment, (AQAA - a selfassessment of performance against the Care Homes Regulations and National Minimum Standards, that all registered care services must provide for CSCI) when we asked for it. Evidence gathered during the course of this inspection generally supported the information in the AQAA. However, the review of policies and procedures was not as comprehensive as the AQAA indicated. The manager referred in the AQAA to the ‘ever increasing mountain of paperwork’, demanded of them. This inspection found some improvement in the home’s records and documentation but, in a number of areas, such as staff records, care plan evaluations, reviews of policies and procedures, health and safety records, the standard of record keeping warranted further attention. However, CSCI found that the owners had taken prompt action to address the immediate requirements from the last inspection to protect people living at the home and that and that attention to the other issues raised by the last inspection had led to better outcomes for the people living at Holyrood House. The manager stated that she did not hold money for the people living at the home. One person had authorised the manager to go to the bank on their behalf but retained responsibility for their own money and paid for things themselves. These arrangements were documented in their care plan. In another situation the manager invoiced the person’s solicitor, sending them all the receipts, and the third person’s relative provided them with everything they needed and reimbursed the manager against receipts for expenditures, such as hairdressing. The member of staff on duty said that they met daily with the manager as they worked together. This person did not feel that formal supervision could add to the support they received. All the safety issues, identified at the last inspection had been addressed, including testing / servicing of fire extinguishers, gas and electrical installations, portable appliances and hoists. Suitable arrangements had been made for washing hands to reduce the risk of cross infection. Records showed that smoke alarms had been cleaned and monthly testing of the fire bell was taking place. One of the registered providers said they would introduce monthly visual checks of all the fire equipment. The fire risk assessment, completed on 7/11/07, referred people to a set of ‘procedures in case of fire’. These procedures had not been dated, so it was not possible to tell whether they were still valid. A notebook was used for recording accidents to people Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 24 living and working at the home. The manager said she would contact the Health and Safety Executive (HSE) for advice on recording accidents to staff and people living at the home, as the notebook in use did not meet requirements for the confidentiality of individual records. Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13 (2) Requirement Arrangements for the administration of medicines in the care home must comply with safety requirements and relevant legislation so that, as far as possible, mistakes in administration are avoided. Before employing staff the home must obtain all the documents and records that are required to protect residents from people who should not be working with them. Prospective employees must give a full employment history so that any gaps can be explored. Timescale for action 07/12/07 2. OP29 17 Sch 4 & 19 Sch 2 18 07/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 27 1. OP7 Monthly evaluations of care plans should be documented to show individual progress in relation to the plan. It is not sufficient to give a date without any comment. The home’s medication policy should be reviewed in the light of the findings of this inspection. It is good practice to document any key points and decisions in one to one discussions with staff to evidence that the person is receiving appropriate supervision and support for their professional development. 2. 3. OP9 OP36 Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Holyrood House DS0000017852.V355355.R01.S.doc Version 5.2 Page 29 - 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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