Care Home: Hollin Knowle

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What the care home does well People told us they were happy with the care they received at the home. They said, "we`re well looked after", "you get the care that you need", "I`m lucky to have found this home", "I am happy and content and would recommend this home to friends", and, "If I have any worries there is always someone to help". People told us the staff were always polite and friendly, and "very patient". A relative said, "my mother is always shown great kindness and care". 12 out of 14 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. This exceeded the national minimum standard of 50% of care staff with NVQ. What has improved since the last inspection? Care plans had improved with more detail of the person`s preferred daily routines, likes and dislikes. Nearly all of the staff had received training about safeguarding vulnerable adults and infection control to ensure that people in the home were protected. The decoration of all the bedrooms had been completed. Staff records included all the required information and were better organised. What the care home could do better: Some further attention to the interior and exterior of the home is needed to ensure a safe and pleasant environment for people living there. The induction training programme for new staff should meet the Skills For Care standards to ensure staff are trained to nationally recognised standards. The quality assurance system should be developed to include the views of people living in the home, staff, and others involved. An annual report should be produced and made available to people in the home and their representatives showing the action taken based on their views. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollin Knowle 78 Fairfield Road Buxton Derbyshire SK17 7DR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rose Moffatt     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Hollin Knowle 78 Fairfield Road Buxton Derbyshire SK17 7DR (01298)22534 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ss_islam@yahoo.co.uk Mr Mohammed Shamsul Islam,Mrs Shajeda Islam care home 19 Number of places (if applicable): Under 65 Over 65 19 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Hollin Knowle is a care home registered to provide personal care and accommodation for up to 19 older people. The home is situated on the outskirts of Buxton town centre where a range of amenities is available. Local shops are near to the home. Accommodation is provided over 3 floors with access by a passenger lift. There are 2 lounge areas and a dining room. There is a small sitting area on the first floor next to bedrooms. There are gardens and a car parking area. Information about the home, including CSCI inspection reports, is available at the home or from the owner-manager. Fees at the home range from £364.07 to £373.17 per week. This information was provided by the owner-manager on 28th April 2009. Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of this home was on 29th April 2008. We looked at all the information we have received, or asked for, since the last key Care Homes for Older People Page 5 of 25 inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 7 hours on 28th April 2009. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 10 surveys to people living in the home and received 4 completed responses. We sent out 10 surveys to the relatives or representatives of people living in the home and received 3 completed responses. We sent out 10 surveys to staff employed at the home and received 5 completed responses. There were 16 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The owner/manager was available and helpful during the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 3 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a detailed assessment process so that people were confident that their needs could be met at the home. Evidence: People told us they were happy with the care they received at the home. They said, were well looked after, you get the care that you need, and, Im lucky to have found this home. People told us their needs, or those of their relatives, were always met at the home. From observation, discussion with staff, and looking at care records, we found that peoples needs appeared to be met at the home. The AQAA said that each person had a full needs assessment at the point of moving into the home, and that the assessments involved the person, their relatives and any Care Homes for Older People Page 9 of 25 Evidence: relevant professionals. Standard 6 did not apply as there were no people receiving intermediate care in the home. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made to ensure a more consistent approach to care planning so that people received care to meet their needs. Evidence: People told us they always had the support they needed with personal and healthcare. They said they could see their GP and other healthcare professionals, such as the chiropodist and optician, as necessary. We looked at the care records of 3 people in the home. Each had a care plan that had been signed by the person to indicate their agreement and the care plans had all been reviewed monthly. The care plans had sufficient detail of the action required by staff to meet the needs recorded. The care plans had a few gaps where assessed needs were not included, for example, one care plan did not cover the persons nutritional needs even though the daily records showed the person often refused meals. There were good details of each persons preferred daily routine, likes and dislikes. Care Homes for Older People Page 11 of 25 Evidence: Each person had appropriate risk assessments in place, including an assessment of their risk of developing pressure sores. One person had been assessed as high risk of developing pressure sores on admission to the home but there was no care plan in place. The manager said the person was no longer high risk, but there was no review of the pressure sore risk assessment to show this. Each person had an assessment of their manual handling needs and staff had received appropriate training. We observed that wheelchairs were used without the footplates in place. The manager said that this was because some people could not keep their feet on the footplates. There was a risk assessment in place for one person who had been assessed by a physiotherapist. Medication was securely stored and was administered by staff who had received appropriate training. Since the last inspection, the care plans had been updated to include the assistance required with medication, though this was not clear in one of the records seen. The care plans did not have sufficient detail about medication prescribed as required. There were satisfactory records of the receipt and disposal of medication. Administration records were mostly correctly completed, although there were a few gaps where medication had been given but not signed for. Care staff had hand-written administration details on some records but had not signed the entries. Any homely remedies given were in accordance with the homes policy and were recorded on the administration records. From observation and discussion with people in the home, we found that people were treated with respect. People told us the staff were always polite and friendly, and very patient. A relative said, my mother is always shown great kindness and care. The AQAA said that the care plan was generated from the needs assessments to provide the basis of the care delivered. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a suitable range of activities, flexible routines, and wholesome meals so that the lifestyle offered in the home met the needs, preferences and expectations of people living there. Evidence: People told us they took part in activities such as a monthly church service, visiting musicians, bingo, watching television, and making Easter cards and decorations. Some people had a daily newspaper delivered. The home had taken part, and won a prize, in the local annual carnival. There were good details of each persons preferred daily routines in the care records. People told us they could get up and go to bed when they wanted to. We observed there was a relaxed atmosphere in the home. People in the home were not formally consulted about their life in the home - there were no regular meetings for people or their representatives. Surveys were sent out annually to representatives, though not directly to people in the home. The manager said people and/or their representatives were encouraged informally to give their Care Homes for Older People Page 13 of 25 Evidence: opinions and ideas. People told us that visitors were always made welcome and relatives were kept up to date with any concerns about the person. One person said that staff helped them to keep in touch with family and friends. The menu was displayed in the dining room, but people who chose to stay in their bedrooms did not see a menu. The choice of drinks available was also displayed in the dining room. The menus were varied with mainly traditional meals. People told us they usually enjoyed the meals provided. There was no choice on the menu for the main lunchtime meal, but people were offered an alternative if they did not want what was on the menu. The AQAA said that the home provided flexible routines and varied activities. Also, that people in the home received made to order fresh meals. Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory systems in place and good staff awareness so that people were protected and their concerns effectively dealt with. Evidence: People told us they could talk to someone if they had any concerns and most people knew how to make a formal complaint. They said, If I have any worries there is always someone to help. Most people said any complaints or concerns were dealt with appropriately. There had been no complaints made to the home or to CSCI/CQC since the previous inspection. The manager said that complaints were usually raised directly with her or with senior staff and were dealt with promptly. Since the last inspection, nearly all the staff had received training about safeguarding vulnerable adults - only staff more recently recruited had not had this. Staff were aware of the correct procedures to follow if abuse was suspected. The AQAA showed there were relevant policies and procedures in place and that these had been recently reviewed. Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, suitably equipped, and sufficiently maintained so that people lived in a safe, pleasant environment that met their needs. Evidence: People told us they found the home comfortable and homely. They said, I have a nice room, I really appreciate it. One person commented I wish the home was a little more inviting from the outside! The garden is neglected and the building is in need of a lick of paint. Most people said the home was always clean and fresh. The programme of redecoration had continued at the home after the last inspection. The manger said that all the bedrooms had now been redecorated. There were 2 bedroom windows in need of repair or replacement that the manager said were to be replaced in the summer. The manager also said the kitchen was to be completely refurbished and the gas central heating boiler was to be replaced. Work had been started to repaint the front entrance. All the staff had received training about infection control. Staff were aware of infection control procedures and were observed to use disposable gloves appropriately. The home appeared clean throughout on the day of the inspection visit and was free from offensive odours. The laundry was suitably equipped. Most people said they were Care Homes for Older People Page 16 of 25 Evidence: happy with the laundry service, though 1 person said they sometimes had problems getting clothes back from the laundry, and another said more care was needed with laundry. The AQAA gave details of specialist equipment provided to meet peoples needs. The AQAA said the home had a policy for preventing infection and managing infection control, but this could not be found during the inspection visit. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made to staff records and staff training so that people in the home were protected and their needs were met by a well motivated staff team. Evidence: People told us the staff were always available when needed. They said very good staff, caring and hard working, and, I think another staff member would be beneficial on each shift. Staff told us there usually enough staff to ensure peoples needs could be met. We looked at the records of 3 members of staff and found all the required documents and information were in place. The staff records were better organised than at the previous inspection. New staff completed an induction programme, though this did not meet Skills For Care standards. Training records showed that staff were up to date with required training, such as manual handling, infection control, and safehandling of medication. Staff had also received training about the care of people with dementia and about the Mental capacity Act 2005. 12 out of 14 care staff had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. Care Homes for Older People Page 18 of 25 Evidence: We looked at the staff rotas and found that there were 3 care staff for the morning shift from 7am to 2pm, 2 in the afternoon from 2pm until 7pm joined by a third care staff from 7pm to 9pm, then 2 care staff overnight, 1 waking and 1 sleeping between midnight and 6am. There was no use of agency staff. Care staff were supported by a domestic assistant and a cook each day. The AQAA showed a low turnover of staff at the home and said that the home planned to improve the staff appraisals, training and development in the next 12 months. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made in several areas so that people benefited from a well organised home and their health and welfare were better promoted. There was little formal evidence that the views of people in the home were listened to and valued. Evidence: Most people were positive about the home. They told us, I am happy and content and would recommend this home to friends, and, very happy with everything. One person felt their concerns were not always listened to and acted on. The manager had owned and run the home for many years. People told us shes very kind and most people said they had confidence in her to sort out any problems. Staff told us the manager was hands on, approachable, and easy to get on with. Staff told us they generally felt well supported and had relevant training to ensure they could meet peoples needs. They said that communication between staff at the Care Homes for Older People Page 20 of 25 Evidence: home could be improved. The AQAA was completed by a member of the management team. The self assessment section of the AQAA gave little useful information about the home. There were few details of how the home had improved in the last 12 months, or of their plans for future improvement. There were gaps and inconsistencies in the information provided in the self assessment and data sections. The AQAA said that A formal performance measurement system based on the Department of Health national care standards and the care home regulations 2001 was implemented last year at Hollin Knowle. The AQAA did not give examples of what this system had achieved or if it had highlighted areas for improvement. The AQAA said that the home had implemented quality assurance and quality monitoring systems based on seeking the views of service users. However, there was little evidence of this available during the inspection visit. The manager said that the views of people in the home were sought at individual care reviews. She said that quality assurance questionnaires were sent out to peoples relatives annually. The manager said there were no meetings for people in the home and / or their representatives, and questionnaires were not given out to people in the home or to staff. There was no annual report available of the findings of quality assurance measures and the action taken to address any issues raised. Personal money held for people in the home was stored securely. There were satisfactory records of all transactions, signed by a member of staff and the person wherever possible, or by 2 members of staff. The AQAA showed that the maintenance of systems and equipment in the home was up to date. We looked at records of the testing of fire systems and equipment and found these were up to date. Since the last inspection, the manager had sent us the required notifications of deaths and other events in the home. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Where people in the home 30/06/2009 choose not to use the footplates on wheelchairs, there must be a risk assessment in place showing the risks to the person and the action to be taken by staff to minimise those risks. This will help to protect people and minimise the risk of injury. 2 19 23 The 2 identified bedroom windows must be replaced or repaired. This will help to ensure a secure and comfortable environment for people in the home. 30/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 25 1 9 There should be more details in the care plan about medication prescribed as required to ensure people receive medication correctly. There should also be details of any alternative action for staff to offer. There should be regular meetings for people in the home and/or their representatives to share opinions and ideas for improving the lifestyle in the home. Every person in the home should have access to a daily menu so they are fully informed about the choices available to them. The induction training programme for new staff should meet the Skills For Care standards to ensure staff are trained to nationally recognised standards. The quality assurance system should be developed to include the views of people living in the home, staff, and others involved. An annual report should be produced and made available to people in the home and their representatives showing the action taken based on their views. 2 14 3 15 4 20 5 33 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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