Care Home: Holehird - Leonard Cheshire Disability

What the care home does well Holehird provides good information for people interested in using the services they offer. Admission arrangements are thorough for new people moving into the care home or going for respite care. People have an Individual Service Plan (ISP) which details exactly what care they need, and how they like to receive it. These are very detailed, written in a person centred way, and show that people`s personal wishes and choices are included. People were pleased with the delivery of care and told us it suited their needs. There were good arrangements in place for people to access healthcare services, and staff worked closely with a number of specialists to provide good all round care for people with complex needs. There was an excellent provision of activities and occupation, which everyone was helped to access at some level. People felt the use of overseas and local volunteers enriched their lives. People were pleased with the catering and spoke highly of the quality and choice of meals served. Special diets were catered for without any problem. The home is well adapted and suitability equipped for people with physical disabilities, and has generous communal and outside space. Staffing arrangements are good, with thorough vetting procedures for new staff in place. There was a detailed induction training programme and a probationary period for new staff. All staff received regular training updates and a high percentage of care staff had a National Vocational Qualification in care.The home was well managed and operated a thorough quality assurance process, and health and safety checks, to maintain the standard of service provided. What has improved since the last inspection? Since the last inspection the assessment process for people coming for repeat respite care had been improved, to ensure care records were fully updated to include any changes in the person`s needs or wishes since their last visit. Staffing levels had increased and working teams re-allocated to make the day run smoother and ensure people were given the support they needed at the right time of day for them. This had enabled more people to join in the morning activities, and reduced the time waiting for care which some people had been experiencing. More effort had also been made to make activities and occupation available to those more dependant people who spend a lot of time in bed. Improvements had been made in the handling, storage and recording of medicines. Many environmental improvements had taken place to freshen up the home. Eight bedrooms had been refurbished with new decoration, furniture, fabrics and carpets where needed. Corridors had also been decorated and given new carpets. One additional ensuite bathroom had been provided. Outside, the patios had been cleared and there were new hanging baskets and two new canopies had been purchased to provide shade and shelter. CARE HOME ADULTS 18-65 Holehird Lake District Cheshire Home Patterdale Road Windermere Cumbria LA23 1NR Lead Inspector Jenny Donnelly Unannounced Inspection 3rd September 2008 09:15 Holehird DS0000006133.V370758.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 Holehird DS0000006133.V370758.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. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holehird Address Lake District Cheshire Home Patterdale Road Windermere Cumbria LA23 1NR 015394 42500 015394 45707 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.leonard-cheshire.org.uk Leonard Cheshire Disability Mr Alan Barton Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (6) of places Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 29 service users to include: up to 29 service users in the category of PD (Physical disabilities) up to 6 service users in the category of PD(E) (Physical disabilities over 65 years of age) The number of places providing nursing care must not exceed 25. Date of last inspection 10th September 2007 Brief Description of the Service: Leonard Cheshire operates Holehird. The building is a Victorian mansion, with a modern extension and is situated about two miles from the town of Windermere. It is set above the lake with beautiful views of the lake and the surrounding mountains. There is a large car park and adjacent public gardens, which are managed by the Lakeland Horticultural Society. The home has two floors served by a passenger lift, and residents’ bedrooms are situated on both floors. The communal and recreational rooms are on the ground floor. There is a physiotherapy room, and the home has been adapted with overhead hoist tracking in the majority of bedrooms and bathrooms. The manager Alan Barton had been in post since summer 2005, and is registered with CSCI. The weekly fees at Holehird are set in accordance with each service users’ assessed care needs. The range of fees for current service users ranged from £619.00 to £1081.00 per week. Information about the home, in the form of a service user guide, can be viewed at the home or copies requested. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the main or ‘key’ inspection of the service. Jenny Donnelly inspector, made an unannounced visit to the service on 3rd September 2008. During the visit we (the Commission) toured the building, spoke with residents, visitors, staff and the management. We looked at care, medication, staffing and management records. We saw how people were spending their day, and observed some of the day’s activities. Prior to this inspection the registered manager had completed and returned an Annual Quality Assurance Assessment (AQAA) that we had requested. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys out to some of the people who live in the home and to staff. The findings of the surveys are included in this report. What the service does well: Holehird provides good information for people interested in using the services they offer. Admission arrangements are thorough for new people moving into the care home or going for respite care. People have an Individual Service Plan (ISP) which details exactly what care they need, and how they like to receive it. These are very detailed, written in a person centred way, and show that people’s personal wishes and choices are included. People were pleased with the delivery of care and told us it suited their needs. There were good arrangements in place for people to access healthcare services, and staff worked closely with a number of specialists to provide good all round care for people with complex needs. There was an excellent provision of activities and occupation, which everyone was helped to access at some level. People felt the use of overseas and local volunteers enriched their lives. People were pleased with the catering and spoke highly of the quality and choice of meals served. Special diets were catered for without any problem. The home is well adapted and suitability equipped for people with physical disabilities, and has generous communal and outside space. Staffing arrangements are good, with thorough vetting procedures for new staff in place. There was a detailed induction training programme and a probationary period for new staff. All staff received regular training updates and a high percentage of care staff had a National Vocational Qualification in care. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 6 The home was well managed and operated a thorough quality assurance process, and health and safety checks, to maintain the standard of service provided. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 7 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 Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 8 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 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care home provides good information for people about the services and facilities on offer, and carries out thorough pre-admission assessments, which helps to ensure Holehird is a suitable place for people before they move in. EVIDENCE: Holehird has produced good information for prospective clients, in the form of a statement of purpose and service user guide, which details the service offered and type of clients catered for. The manager had updated these documents earlier in the year, and they were displayed in the entrance foyer. There were also some additional leaflets setting out Leonard Cheshire’s expected service standards and the complaints procedure. Leonard Cheshire has a standard pre-admission assessment used to assess all potential new clients. This takes into account information from other agencies such as hospitals, social workers and healthcare specialists. The assessment process involves a senior member of Holehird staff visiting the prospective client, either in their own home or in hospital. This information is used to assess whether Holehird would be a suitable placement for the individual and to assess the fee level. Since the last inspection the service has tightened up the pre-admission procedure for regular respite clients, to capture any changes in peoples condition or needs since their last visit. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 9 Surveys told us people were generally well informed about their move to Holehird, and about the terms and conditions of their stay. One person told us; • “I had information because I had been here on respite, it is like a second home”. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans of care are drawn up jointly between staff and service users and these show clear evidence that people’s personal choices and decisions are taken into account. EVIDENCE: Each person has an “Individual Service Plan”, called an ISP, in place. These are drawn up with the involvement of the person and are written in the first person, for example, “I like to have …, It is important for me to …”. We looked at two plans in detail and at several others in less detail. The plans were of a good standard and had been kept under review and updated as needed. Staff had introduced a new monthly review tool that was simpler and quicker to use. Plans clearly showed individuals’ wishes and choices and set out short and long-term goals and aspirations people hoped to achieve. There was evidence that people were enabled to make decisions about their life, and there was good information to describe the level of support people needed, and also to show any areas of life people preferred to manage for themselves. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 11 There was evidence in the plans that people were able to have control over their own lives. One person did not wish have to have a written plan of daily care and staff had agreed with the person a minimum amount of information to be held on record. Risk assessments and agreements had been completed with individuals about specific aspects of their life. These were personal to each individual rather than blanket statements, and included things such as the use of motorised wheelchairs or other equipment, going out of the home/grounds alone and self-management of finances and/or healthcare arrangements. Any limitations on people’s freedom and choices were clearly discussed and documented. The surveys responses about individual needs and choices were positive, and one person said; • “We are very satisfied with the home now”. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Holehird provides a wide range of activities and opportunities for people to engage with, and helps people maintain their skills and mix with the local community. EVIDENCE: Holehird employs three part time activities co-ordinators, along with a number of local and overseas volunteers, to promote entertainment and occupation for people. There was a very good amount and range of activities on offer. During the inspection we saw groups of people participating in word puzzles, ball games, reading and discussing the daily newspapers and engaging in general conversation throughout the day. We saw visitors also helping out and joining in with activities. There were photographs on display of various outings and events that had taken place over the summer. These included a Leonard Cheshire 60th Anniversary garden party with a band, a floral hanging basket competition and baking/cooking sessions. There were adverts for forthcoming Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 13 bus trips, a cinema evening and themed days. The home had access to three wheelchair accessible vehicles and used volunteer drivers for outings. Some people also had individual arrangements to spend time out of Holehird with family and friends, and were able to regularly visit the town for social events or shopping. The home has a separate domestic kitchen people can use for pleasure or occupational therapy purposes. This has been more widely used over the last year for group and individual cooking sessions. One person who wished to had been enabled to plan, shop and cook full meals for themselves. There were two computers, one with broadband access, and the activity co-ordinators or volunteers helped people use these as needed. Staff had made contact with local education providers to find out about suitable education and training courses, but no one had wanted to pursue these at present. Further to comments made at the last inspection, people said they were better able to access activities now as care staffing levels had increased. This meant people could be up and about earlier in the day if they wanted to join in morning activities. We also noted some of the more physically dependent people were up and about joining in or observing activities. Care records confirmed that these individuals were spending fewer hours in bed and having regular time up in the main lounge or outside in the garden. Three people had been on a summer holiday this year either with family/friends or to a fully staffed disabled holiday care centre in Southport. We received more positive comments about activities this year, although one person said they would like more trips out, another told us; • “I enjoy the activities that are run, and the fun you get out of it and being part of the group”. People commented very positively on the provision of meals, saying there was always a choice and the food was very good. There were daily menus on display that showed meat and vegetarian options. The kitchen staff were aware of peoples’ preferences and automatically provided alternatives where needed. People told us; • “There is plenty of choice and variety” • “I enjoy the meals” • “The food is always very good” One person said, “Tea time is repetitive”. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 14 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were receiving a god standard of personal and healthcare support which promoted their general well being and health. EVIDENCE: Service user care plans set out in detail what care people needed and what their individual preferences and wishes were in relation to this, such as whether they were happy to have male and/or female carers. People’s specialist aids and equipment needs were fully recorded and there was evidence that aids and equipment was regularly checked and serviced and that people received good instruction on how to use these. In the past people had complained about having to wait unduly for their personal care, but with the increased staffing levels this was no longer such a problem. People told us they were well looked after and received good care, saying; • “I get the care and support I need, but sometimes have to wait when several people need help at once” • “I am very well looked after”. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 15 The home used the services of two GP practices in the area, although the majority of people were registered with one practice. There was written evidence that people were able to access a range of healthcare services including dentistry, eye tests and chiropody. For people with very complex conditions there were regular team reviews, which included physiotherapy, occupational therapy, dietician and consultant input. The home also maintained links close with the acquired brain injury team. Holehird has a well-equipped physiotherapy department, staffed by a qualified physiotherapist and an assistant. People told us their healthcare needs were well attended to; • “I’m pleased with the medical support”. Inspection of the medicines showed that staff had tightened up on medicines records since the last inspection, and records were now accurately maintained. A system of checks and audits had been put in place to ensure the standard of record keeping was upheld. An audit of some medicines showed the stock balance to be correct and all tablets accounted for as administered or wasted/destroyed. There were set Leonard Cheshire risk assessment documents in place to assess the competence of people wishing to manage their own medicines, but no one was currently doing so. People did have secure storage in their bedrooms for this purpose if they so wished. The home kept a supply of non-prescribed items for the treatment of minor ailments that were authorised for use by peoples doctor. This benefits people as they can receive treatments for things such as minor pain without waiting to see the doctor. Medicines storage was clean, tidy and well organised, and a second medicine trolley had been provided to allow additional storage space. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People knew how to raise concerns and complaints and felt confident they would receive an appropriate response. Staff had been trained in safeguarding procedures and understood their responsibility to protect people. EVIDENCE: Holehird has a complaints procedure, a copy of which is handed to all service users and their relatives at the time of admission. The information is also displayed prominently in the home. People said staff listened to them and they knew how to make a complaint. Surveys told us; • “I can always speak to the manager or whoever is in charge” • “I feel people would deal with it if I had a complaint” • “We are content with things”. The manager reports there were no formal complaints in the last year and none had been made directly to the inspector either. There had been a case of money going missing and this had been reported to the police and followed up accordingly. The service had a compliment file containing letters and cards of thanks and appreciation from past service users. All but one staff member had attended training in safeguarding adults over the last year. This training covered types of, and recognition of abuse and reporting procedures. Senior staff were aware of the process for reporting safeguarding issues, and there were polices and procedures in place to remind Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 17 and guide staff what to do in the event of an allegation being made. There had been no such allegations since the last inspection. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 18 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, 26, 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Holehird provides a suitable environment that enables people with physical disabilities to be as independent as possible. The current refurbishment work is making the home a more pleasant and comfortable place to live. EVIDENCE: Holehird is a grade 2 listed building both internally and externally, which complicates any planned improvements. The main building of the home has two floors served by a passenger lift, and there is a single storey modern extension to one side. There is also a platform lift on the upstairs corridor where the floor level changes. The communal rooms are large and corridors are spacious and allow good wheelchair access. There is a large communal activity room, a smaller craft area, a separate domestic kitchen with its’ own dining area, the main dining room, a dining conservatory, a smoke room and a library. The announcement in 2003 that Leonard Cheshire intended to move off the Holehird site led to a reduction in the level of repair and redecoration. The Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 19 recent decision by Leonard Cheshire to remain at Holehird for another five years has allowed refurbishment works to be funded. Some people had decorated and furnished their own bedrooms privately to a very high standard. Since the last inspection the manager identified 15 bedrooms in need of refurbishment and eight of these had so far been completed, with new décor, furniture, fabrics and carpets where needed. People had been asked to choose the colours for their bedrooms. The entrance area and ground floor corridors had been decorated and new carpets provided. One bedroom had been fitted with an ensuite bath with overhead hoist. There was a new training/meeting room and there are plans to upgrade one of the baths. The controls for the platform lift on the landing had been moved to allow people easier operation of the lift. Toilets and bathrooms were spacious and were suitability adapted to meet peoples moving and handling needs. There are extensive grounds, which are mostly wheelchair accessible, with views over lake Windermere to the fells beyond. The home employs a handyman, and there were records of equipment checks and servicing of facilities. The outside patio areas had been cleaned of moss and weeds, and made attractive with flowers and shrubs, and two new canopies had been purchased. There is an on site laundry which was upgraded last year, and there were adequate sluicing facilities. The home was clean, hygienic and fresh smelling. Staff had received training in infection control, and were aware of good practice and were suitably equipped with gloves and aprons. People told us; • “The cleaners on the whole do a good job”. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by sufficient numbers of well trained, competent and caring staff, who have gone through thorough pre-employment checks. EVIDENCE: Leonard Cheshire provides a comprehensive training package for staff, which is managed by regional training officers. All new staff undergo disability awareness training and complete a thorough induction programme during their probationary period. We saw evidence that the majority of staff had attended regular mandatory training including fire safety and safe moving and handling techniques. There had also been a number of care related topics such as diabetes, management of medicines and infection control. There continued to be some discrepancy and confusion between the training records held by the regional training officer and those held by the home manager, and this should be resolved. Over 70 of the care staff have completed a National Vocational Qualification (NVQ) in care, which is very good. Further to concerns raised at the last inspection, staffing numbers had been consistently increased. Rotas showed there were generally two nurses plus the care supervisor and eight care staff during the day. There were occasions Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 21 when there were more. There was a generous shift overlap, which provided extra staff over the busy lunch period. The arrangement of staff teams had been changed to make the allocation of care more streamlined and reduce waiting time for people. We saw that many people, who wanted to, were up in time for the morning activities. The home had recently lost three overseas nurses who had returned to their home country. These posts had been recruited to, with minimal use of agency staff during the interim period. The home did not have any staff vacancies at the time of our visit, in fact they had potential staff waiting for vacancies. With the exception of the above the service had not used any agency staff. People we spoke to were very positive about the staff, although two surveys still felt staff recruitment was a problem. We received some staff surveys, which told us; • “I had a good induction period and shadowed for the first 2 weeks” • “I was offered and completed NVQ which was really helpful” • “ The way people are looked after is good, I think people are happy to have a good relationship with the staff and it makes it more like home for them” Further to the last inspection staff files had been audited and brought up to date. We inspected the files of four staff new to the home since our last inspection and found these were in order. There was evidence that all necessary recruitment checks had taken place and staff had completed an induction programme. There was a system of annual appraisal and formal supervision for all grades of staff. We saw the nurses’ appraisals were all up to date, but some care staff supervisions were overdue. It is recommended that the manager firm up the arrangements for this. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 22 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, 40 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is competently and safely managed and the people who use the service are able to voice their opinions in how the service operates. EVIDENCE: The manager, Mr Alan Barton, is suitably qualified and is registered with the Commission for Social Care Inspection. He has been in post at Holehird since summer 2005, and is well supported by Leonard Cheshire. The service has a quality assurance system in place, which includes annual surveys and self audits. Through these manager can target any highlighted areas of weakness and know whether improvements made in the past have been sustained. The system also enables people who live in the home to put forward their views and suggestions. A system of staff meetings and memos Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 23 helps staff keep abreast of new information and changes to working practice. Although people have chosen not to have a Service User Forum, the home still receives visits from the Leonard Cheshire service user forum support team, who talk with people about the standard of service provided. The home is subject to a number of external audits by various Leonard Cheshire departments including the quality team and health and safety officers. The registered manager completes an annual self-audit and receives regular visits from his area manager. The care supervisor checks the quality of care records and audits medication records periodically. The manager co-operates well with the commission, and keeps us informed of any untoward incidents as well as any changes taking place within the service. Prior to this inspection the manager submitted a fully complete and detailed Annual Quality Assurance Audit (AQAA) to the commission as requested. This provided us with details of changes that had taken place in the service over the last year and information about future plans as well as some numerical data. The service has a comprehensive set of up to date policies and procedures to guide staff, and promotes equal opportunities for people who use the service and staff. The manager demonstrated that the building and its’ equipment were checked and serviced regularly, and there were detailed health and safety procedures in place to protect people from harm. Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 24 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 X 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 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 3 X 3 x Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations It is recommended that the current refurbishment work continue as planned to improve the whole environment people are living in. It is recommended that all staff training that has taken place, or is due to take place, can be evidenced in the care home. It is recommended that all staff receive regular formal support supervision to help them carry out their roles. 2. YA35 3. YA36 Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North West Region 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Holehird DS0000006133.V370758.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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