Care Home: Heather Holmes Care Home

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What the care home does well What has improved since the last inspection? This is a newly registered service. What the care home could do better: The management need to make sure that residents have contracts that are accurate and up to date. The Expert by Experience commented `residents are given only limited choices about what they do everyday, which means they may miss out on lots. It seems they are not really involved in the running of the home. But only two residents where there at the time of the inspection`. The staff need to keep better records to show how residents are supported to make decisions in their daily lives. Residents should not be prohibited from activities where they can be involved in making decisions without an assessment of their mental capacity and guidance needs to be sought from the Independent Mental Capacity Advocate. Residents need to be asked if they would like keys to the house and their bedroom door. The staff need to do the right checks to see if they can do this safely. Residents who may wish to eat a restricted diet should have the right checks in place to weigh their right to take risks and exercise their choice against possible health risks. The staff need to improve how they record that medication has been given, so that they can tell how much should be left. The management need to improve access to the home for residents who use wheelchairs and consider removing the shower room from the kitchen diner in the upstairs flat.The management need to ask each resident if they want their bedroom doors open during the day and check with the fire officer that it is safe to do so. The management need to tell the Commission when they have fitted the window restrictor to the sitting room window in the flat and made sure that the hot water temperature have been made safe. CARE HOME ADULTS 18-65 Heather Holmes Care Home 64 Rushton Road Desborough Kettering Northamptonshire NN14 2QD Lead Inspector Stephanie Vaughan Unannounced Inspection 3rd December 2007 09:30 Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 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 Heather Holmes Care Home DS0000069682.V354857.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 Adults 18-65. 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. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heather Holmes Care Home Address 64 Rushton Road Desborough Kettering Northamptonshire NN14 2QD 01536 760418 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) www.concensusupport.com Consensus Support Services Ltd David Smith Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are: Learning disability - Code LD The maximum number of service users who can be accommodated is 12. New Service 2. Date of last inspection Brief Description of the Service: Heather Holmes is a care home registered to provide personal care for twelve people with Learning Disability. It is a detached Victorian styled domestic residence situated within a residential area close to the town centre, transport links and local amenities. It is located within pleasant gardens. There are adequate parking facilities, however the front drive is steep and has the potential to restrict independent access for people who use wheelchairs. The home has been extended to provide each resident with their own bedroom and there are three communal areas on the ground floor. There is a selfcontained flat on the first floor, which provides accommodation for four of the more independent residents. The fees range from £550.00 per week to £1.500.00 per week with additional charges for personal items such as toiletries, and services such as hairdressing, private chiropody and contributions towards transport costs. The service provides information about the home and the Commission for Social Care Inspection reports to new and exiting residents in the Service Users Guide. The inspection reports are available in the home on request. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to this statutory inspection, a period of two hours was spent in preparation. This comprised reviewing the registration report, the service history and other documentation. The Annual Quality Assurance Assessment was received during the inspection therefore no comment cards were distributed to residents or their representatives prior to the inspection. The Commission have received no complaints, concerns or allegations about the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of six and a half hours during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the resident’s private accommodation. There were no relatives present and the residents spoken to during the inspection have limited verbal communication abilities, in these circumstances observations have been used to inform the inspection process. Case tracking is the method used during inspection where of a sample of two residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The Manager was present during some of this inspection. An Expert by Experience was present during the afternoon; this is someone who works with the Commission and who has had experience of using this type of service. Her views about this service are included within the report. What the service does well: Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 6 People who use the service have all the right information so that they know what is provided and the people who might wish to live there can make informed decisions. Each resident has a plan of care that sets out how the resident needs and wishes to be cared for. The standard of these is good, they are person centred and written in formats that are easier for the residents to read. Residents and their relatives are involved in the development of these. Some of the residents are involved in meetings where they can make decisions about the service, plan menus and social activities. All residents are supported to make decisions about their lives. The Expert by Experience commented overall this is a good home, it seemed to have a lot of activities going on inside the home and out at daycentres. The staff and residents seemed to get on well. Residents are able to keep in touch with their families and friends and make use of the local facilities such as shops, pubs, leisure and day centres. They participate in a range of activities such as sailing, swimming, gardening and household chores, staff have the right checks in place to make sure that they can do these activities safely. Routines in the home are flexible and the resident’s preferences are recorded in the plans of care. The staff are nice to the residents and treat them well. The food is home cooked, some residents are involved in the menu planning and the staff know what the residents like and residents are able to make a choice of the options provided on the day. Staff support residents to eat a healthy diet. The plans of care have all the right information so that staff know how to look after the residents properly. These show that residents have all the right healthcare services. The service has the right systems in place to make sure that complaints are managed properly and that residents are protected. Residents are able to personalise their rooms and make decisions about the décor and furnishings. Staffing levels are arranged to make sure that there are enough staff to care for the residents properly when they are needed. Staff have the right checks done before they can start working in the home and have the right training and supervision. The management do the right checks to make sure that the home is safe. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The management need to make sure that residents have contracts that are accurate and up to date. The Expert by Experience commented ‘residents are given only limited choices about what they do everyday, which means they may miss out on lots. It seems they are not really involved in the running of the home. But only two residents where there at the time of the inspection’. The staff need to keep better records to show how residents are supported to make decisions in their daily lives. Residents should not be prohibited from activities where they can be involved in making decisions without an assessment of their mental capacity and guidance needs to be sought from the Independent Mental Capacity Advocate. Residents need to be asked if they would like keys to the house and their bedroom door. The staff need to do the right checks to see if they can do this safely. Residents who may wish to eat a restricted diet should have the right checks in place to weigh their right to take risks and exercise their choice against possible health risks. The staff need to improve how they record that medication has been given, so that they can tell how much should be left. The management need to improve access to the home for residents who use wheelchairs and consider removing the shower room from the kitchen diner in the upstairs flat. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 8 The management need to ask each resident if they want their bedroom doors open during the day and check with the fire officer that it is safe to do so. The management need to tell the Commission when they have fitted the window restrictor to the sitting room window in the flat and made sure that the hot water temperature have been made safe. 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. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive clear information to enable them to make a choice about whether or not they might wish to live in the home. EVIDENCE: The service has a Statement of Purpose, which is up to date and complies with the criteria specified in Schedule 1 of the National Minimum Standards. There is also an up to date Service Users Guide, which contains the right information and is produced in formats appropriate to the needs of prospective and existing residents. The service issues prospective residents with a welcome pack, which contains information about the home including the Service Users Guide, the role of the Commission and access to Commission for Social Care Inspection Reports. There have been no new admissions to the home since the Service changed ownership. However the Registered Manager was able to confirm that the service had access to new policies, procedures and assessments to facilitate the appropriate admission of new residents. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 11 Two residents were case tracked; neither of individual plans of care contained contracts. The Registered Manager confirmed that the contract pertaining to the previous ownership of the service had been sent to the new owners. New contracts need to be issued to ensure that residents have access to up to date and accurate information. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have control over their lives which enable them to enjoy a lifestyle that promotes choice and independence EVIDENCE: Each resident has an individual plan of care, these are currently being reviewed to ensure that the plans are person centred and that the residents are involved as much as possible in the planning of their care. The new plans are written in a user-friendly format, from the resident’s perspective and contain detailed instruction to staff about all aspects of the residents personal, health and social care needs. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 13 Plans also include information to staff about the management of challenging behaviour, including potential triggers and the action that needs to be taken to manage situations. Any restrictions to resident’s activities were seen to be in their best interests and to be supported by appropriate risk assessments. All residents have access to a Key Worker who takes on extra responsibility for the residents that they support, this also includes the regular review of the individual plans of care. Through observation, discussion with staff and a review of the individual plans of care it is evident that in the main the service supports the residents to make decisions for themselves. Individual plans of care contain information about the resident’s preferences, likes and dislikes. More able residents are involved in residents meetings and are encouraged to make decisions about the running of the home including their social activities, menus and how to spend their time. They are also able to opt out of activities should they wish to do so. Some of the residents have chosen to participate in the development of a local branch of the British Institute for Learning Disability whereby they are able to participate in the decisions about service development and plan social activities with residents from other homes in the locality. However the abilities of residents living at Heather Holmes are variable, where residents have difficulty in communicating their views the staff are able to understand the residents preferences using non-verbal communication techniques, a good understanding of the residents lifestyle and consultation with residents families. The Expert by Experience commented ‘Residents are given choices, but not about everything’. Fore example some ‘Residents are not really involved in the running of the home or invited to meetings, because they aren’t thought to be at a level where they can communicate or give any input. – They should be involved anyway, because they might understand and respond to something’. The Service has information about the Mental capacity Act 2005, and should use this to assess residents who may lack the capacity to make decisions for themselves to ensure that residents are not prohibited from exercising as much choice as they are able and fully participating in all aspects life within the home. If it is found that residents lack some capacity to make decisions for themselves guidance should be sought from the Independent Mental Capacity Advocate. Daily records are maintained and demonstrate that the residents received the care that is specified within the individual plans of care. However these would benefit from containing a more detailed record about how the residents are Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 14 supported on a daily basis to exercise choice within their activities of daily living. All of the residents currently living at Heather Holmes have regular contact with their families. The Registered Manager confirmed that they were currently involved in the review of individual plans of care and that they were consulted about all aspects of the residents care. As such none of the existing residents have required input form formal advocacy services, however this information is readily available should they wish to access it. The Expert by Experience provided additional information about independent advocacy services. Residents are supported to take risks within their daily lives and these activities are supported by appropriate risk assessments. Many attend a local day centre that provides access to swimming, sailing and other physical activities. Residents are also able participate in light gardening and domestic activities such as cleaning their rooms, laundry and kitchen activities. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life is managed well ensuring that residents are able to lead a varied and interesting lifestyle. EVIDENCE: Residents are able to participate in work-based activities through attendance at local day centres. The service also has converted the garage to provide an on site Day Centre for the use of some residents. The Expert by Experience commented that ‘the converted garage was nice, lots of games activities, puzzles and very bright. The notice board with peoples’ pictures, showing their likes and dislikes was good’. Residents are able to access the local community and make use of amenities such as the local leisure centre, shop, pubs and restaurants. One resident, Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 16 seemed to do lots of things that she enjoyed, like getting involved in making cakes, going shopping and going out every Thursday to dance at ‘kaleidoscope’. There is evidence that residents are supported to maintain links with family and friends. Residents are able to go on home visits or to receive their chosen visitors in their own home. The Expert by Experience spoke to a member of staff who said ‘X has a sister that comes to visit every week and a niece’ Individual plans of care demonstrate that residents are supported to maintain personal and intimate relationships. The expert by experience was concerned that residents may not have a choice about what time that they went to bed at night. This was discussed with the Registered Manager who was able to confirm that resident’s routines were flexible within the constraints of their planned activities. The individual plans of care for the resident’s case tracked clearly evidenced that residents are able to stay up later if they wish to do so. Although residents are offered a key to a lockable facility within their room there are no privacy locks fitted to the bedroom doors and residents are not consulted about their wish to hold a key either to their bedroom or the front door. This was discussed with the Registered Manager who stated that some of the residents would not have the capacity to open the door if it was left closed or to be able to manage a key. However there was no evidence that residents had been consulted about their views or that risk assessments had been conducted to establish the residents ability to hold either a key to their bedroom or the front door. Staff were seen to relate well to residents and to refer to them by their chosen form of address. The Expert By Experience commented that she had ‘Had a friendly welcome’ at the home and that ‘Staff and residents seem to get on well’. The Service Users Guide contains information about the house rules such as the use of alcohol and tobacco. Lunchtime service comprised a packed lunch with fresh fruit for residents who were out for the day and the remaining residents had sandwiches with spaghetti in tomato sauce. The evening menu comprised homemade lasagne with cauliflower cheese as an accompaniment and also the vegetarian option. Kitchen records demonstrated that the meals were home cooked, varied and nutritious and that residents have choice at meal times. There is evidence that the more able residents are able to participate in planning the menus and where residents are unable to this preferences are known to staff and are Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 17 recorded in the individual plans of care. The residents weight is monitored on a regular basis and guidance is sought from the Dietician appropriately. The Service has been awarded the Heart Beat Award for healthy eating and residents are supported by the staff to balance their preferences whilst continuing to maintain a healthy diet. The Expert was concerned that one staff member had commented ‘someone might want eggs everyday, but that may not be good for their diet so they might get ‘re-directed’. ’Unless, they have a medical condition, they should be allowed to eat eggs everyday, if they want! -Lots of people choose to eat food that is bad for their health’. In these circumstances we, the Commission would expect the service to conduct a risk assessment pertaining to the residents diet and choice of food which would include appropriate controls to minimise any risks associated with a restricted diet and to demonstrate that the residents choice was not unnecessarily restricted. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have detailed individual plans of care, which demonstrates that they are treated as individuals and that their health care needs are fully met. EVIDENCE: Residents appeared well cared for and were well presented. Individual plans of care evidenced that residents are provided with support to maintain their health and personal healthcare needs. The individual plans of care contained good detail regarding the residents preferences and routines and included information about oral health care, nail care, hair care, shaving and other personal health care needs. There is evidence that residents are registered with General Practitioners and are referred appropriately for hospital services. They also have access to other Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 19 health care specialists such as dieticians, podiatrist’s dentist and speech and language therapists. The residents living at the home are predominantly female and the staff group comprises female staff, however the Registered Manager is male and continues to have some regular contact with the residents. Through discussion with the Registered Manager it was established that the management are mindful of the need to ensure that the staff group reflects the gender mix of the client group. The ethnic mix of the staff reflects the current residents ethnic origin. Routines are flexible within the constraints of the residents planned activities and their preferences regarding this are recorded in the individual plans of care. One of the residents selected for case-tracking purposes was seen to be supported to self medicate, an appropriate risk assessment had been conducted and the staff maintained appropriate records. Lockable facilities are also available for safe storage. Medication systems within the home were reviewed and found to be in good order. The medication is dispensed by well-known high street chemist using a monitored dose system. Medication Administration Records were seen to be well maintained and to correspond with the remaining stocks. However one of the medications that was not dispensed within the monitored dose system was also prescribed as a variable dose. The service does not at present record the specific amount administered on each occasion, which means that it is difficult to check the accuracy of the remaining stock. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a robust compliant procedure and good staff awareness and attitudes regarding the Safeguarding of Adults, so that residents felt safe and were well protected. EVIDENCE: The service has a robust complaints procedure, which is included in the Service Users Guide and is produced in formats, which are accessible to the residents. The Annual Quality Assurance Assessment completed by the service indicates that there have been two complaints received by the service within the last twelve months. The complaints file indicated that these had been managed in accordance with the procedure and that appropriate action had been taken to prevent reoccurrence. The service has access to the new Local Authority Guidelines regarding the Safeguarding of Adults; there have been no Safeguarding Adults allegations about this service. Residents were able to confirm that they felt safe living at Heather Holmes and they appeared to be content and well cared for. The Expert by Experience commented ‘Both residents said they liked living there’. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 21 Staff were able to confirm access to training in the Safeguarding of Adults and demonstrate a good knowledge base. The service supports residents in the management of their money. This is stored appropriately within a secure facility and each resident has their own lockable cash box. Appropriate records are maintained, including receipts to demonstrate expenditure and a balance sheet. A spot check was conducted and the reaming cash found to be accurate with the balance bought forward. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is adequate; the identified shortfalls within then environment have the potential to adversely affect the convenience, health and safety of residents. EVIDENCE: The home is suitable for its stated purpose comprising a Victorian style, detached, extended premises, situated within a residential setting close to the town centre and local amenities. It is located within pleasant gardens, which include a green house to assist residents in their gardening activities. There are adequate parking facilities, however the front drive is considerably steep which has the potential to restrict independent access for people who use wheelchairs. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 23 Wheel chair access is also restricted at the main entrance and staff assist residents requiring the use of a wheel chair to use the back door, this also has a small step, which means that independent access to the building is restricted and has the potential to compromise the independence and safety of residents. Residents with limited mobility have access to the ground floor including three communal areas and their bedrooms. The home appeared to be generally safe, clean, comfortable, warm and well ventilated. It appeared to be reasonably maintained however the down stairs communal areas i.e. the hall stairs, main sitting room and dining room are now dated and somewhat worn and in need of refurbishment. The Expert by Experience commented ‘the stairs are very narrow for the feet, could be easy to slip. Also, the patterned carpet on the stairs doesn’t make it easy to see which step you are on’. This was discussed with the Registered Manager who was able to confirm that quotes have been obtained and resident views sought regarding the redecoration of the lounge in the very near future and a development plan has been submitted to address the other shortfalls. Individual plans of care evidenced that residents have risk assessments in place for the use of the stairs and risk of falls. Some of the resident’s bedrooms have already been redecorated; staff confirmed that residents were involved in making decisions about the décor and furnishing of their rooms. The Expert by Experience commented ‘Both residents said that they had chosen their own furniture’. A sample of resident’s rooms were viewed and seen to be comfortable and well furnished. Residents are able to bring their personal possessions into the home and to personalise their rooms and have a lockable facility for safe storage of personal items. Rooms are fitted with radiator guards, however some of the radiators within the communal areas continue to be exposed. The Expert by Experience commented ‘Radiator covers should be on the radiators in all areas of the home’. However the Registered Manager confirmed that risk assessment were in place for the radiators that have not been fitted with covers. At present there are no privacy locks fitted to residents bedrooms and their views regarding this should be sought and the appropriate action taken. The Expert by Experience commented ‘There weren’t any locks on peoples’ bedroom doors. Residents may want to have a lock on their door and a key to their own room and be asked, if someone wants to look in. They may want to have their privacy respected if they had the choice’. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 24 During the day most of the residents bedroom doors are left open, the Registered Manager confirmed that this was done to enable residents to access their rooms independently. However there are no automatic closing devices fitted to ensure safety in the event of fire, although doors situated within the corridors are fitted with automatic closing devices. The Registered Manager confirmed that doors were closed at night and that appropriate risk assessments have been approved by the fire officer at a recent inspection in February 2007. Four of the more able residents live in a self-contained flat on the first floor of the old part of the building, which promotes greater independence. There is a small sitting room, which is well decorated and furnished. However there is a low window at the front of the room that has no restriction and is therefore a potential hazard. The Registered Manager confirmed that a request for a window restrictor had been submitted and that it was anticipated that it would be fitted within the week. The flat also has a small kitchenette and dining area, however there is a small toilet and shower room located within the kitchenette, separated by only one door. This not only reduces the space available within the kitchen diner but also has the potential to present a serious risk of cross infection. The management of the home are mindful of this risk and say that there is also a separate bathroom and additional shower room located on the first floor close to resident bedrooms which are generally used in preference. The hot water supply to the washbasin was checked in one of the resident’s rooms, this was estimated to be well in excess of the recommended 43 degrees Celsius. The Registered Manager confirmed that problems had been identified with the temperature regulation to the rooms in the flat and that the Service Handyman had made some adjustments, which had been unsuccessful. A request for plumbing services had been submitted and repair anticipated within the week. The service has separate laundry facilities, adequate supplies of hot water and appeared clean and hygienic throughout. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service employs appropriate numbers of inducted and trained staff to ensure that residents needs are appropriately met. EVIDENCE: The service appears to employ appropriate numbers of staff to meet the current needs of the residents. At present there are two members of staff on duty throughout the day and there are two other members of staff who work during peak periods, when all the residents are at home. The Registered Managers working hours and domestic support are additional and there is one sleeping staff member on duty throughout the night. Following changes in ownership of the home the staff files are currently being reviewed. However there is evidence that the staff receive appropriate training necessary to their role. Staff members were able to confirm access to induction training, and training in the National Vocational Qualification in Care level 2. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 26 Staff recruitment appears to be managed well; staff spoken to were able to confirm that appropriate recruitment practices are in place. The staff file of a member of staff recruited since the change of ownership to the company evidenced appropriate recruitment processes including two written references and Criminal Records Bureau Clearances prior to the commencement of employment. Staff files evidenced that in general staff have appropriate mandatory training and training specific to the needs of the residents, examples include First Aid, Basic Food Hygiene, Fire Safety, Safe Administration of Medication, Movement and Handling, Health and Safety, Infection Control, management of epilepsy, counselling skills and speech and language therapy awareness. Staff spoken to were able to confirm appropriate access to training. The Expert by Experience commented ‘One member of staff said she had lots of training and that they are good on training. She had medication awareness training, manual handling and was about to do a food hygiene training’. The service has conducted a recent training audit and further training has been scheduled to ensure that all staff have access to all of the required training. Further training has been scheduled in the Safeguarding of Adults. There was evidence that staff are in receipt of regular supervision on file in the office and this was confirmed by staff. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate leadership, guidance and direction means that the service is managed in the best interests of residents. EVIDENCE: The Registered Manager was present for some parts of the inspection. He has many years experience working in a caring environment, with people with learning disability and appropriate qualifications. The provider conducts monthly Regulation 26 inspections, action plans are developed and both are forwarded to the Commission Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 28 Quality Assurance systems appear to be in place and comprise of annual satisfaction surveys for residents, relatives and other stakeholders such as care managers and other significant professionals. Regular audits are conducted on the of the medication systems, residents money, staff files and staff training. The Registered Manager confirmed that weekly environmental audits were conducted to identify any Health and Safety and repair issues. As a result problems with the hot water temperatures and the window restrictor have been identified and non-conformance reports sent to the provider for urgent action. Risk assessments have been put in place in the interim and resolutions are anticipated within the week. Appropriate kitchen records are maintained and equipment and systems are checked appropriately. Safe working practices are ensured through mandatory staff training and appropriate risk assessments. Accident records are maintained however there have been no incidents involving residents since the changes in ownership of the home. Staff have access to a comprehensive range of up to date polices and procedures specific to the new ownership of the service. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X X 3 Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 13.4 Requirement Timescale for action 01/03/08 2. YA24 23.4 3. YA24 37.1 Access to the home must be reviewed to ensure that residents who require the use of a wheelchair have convenient and safe access. The Fire Officer must be further 01/03/08 consulted about the risks associated with open bedroom doors to ensure the safety of residents and the Commission notified about the outcome. The Commission must be notified 01/03/08 when the fitting of window restrictors and the hot water temperatures has been completed to ensure the safety of residents. Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 31 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 YA5 YA7 Good Practice Recommendations New contracts should be issued to ensure that residents have access to up to date and accurate information and a copy should be held on the individual plans of care. Residents who are perceived as unable to make decisions should be assessed regarding their Mental Capacity and appropriate guidance sought from the Independent Mental Capacity Advocate. Daily records should be further developed to record and demonstrate how residents are supported to make choices in their activities of daily living. Residents should be consulted about their wishes regarding their bedroom doors being left open during the day and their ability assessed to have keys to their bedrooms and the front door. Residents who may express a wish to eat a restricted diet should have risk assessments conducted to weigh the health risks associated with a restricted diet against their right to take risks and exercise their choice. Stock control systems should be further developed to ensure that when residents are prescribed regular medication that is of variable dose i.e. 1 or 2 tablets. The amount administered should be accurately recorded in order that the remaining balance on the Medication Administration Records can be checked against the remaining stock. Consideration should be given to the removal of the shower and toilet room located within the kitchen diner on the first floor 3. 4. YA7 YA16 5. YA17 6. YA20 7. YA24 Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Heather Holmes Care Home DS0000069682.V354857.R01.S.doc Version 5.2 Page 33 - 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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