Care Home: Holme Manor Care Home

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What the care home does well Detailed information was collected about prospective residents, before admission to the home, to help to determine whether they could be looked after properly. There were clear policies and procedures to support staff with the safe management of medicines and staff had received training to help them to manage residents medicines safely. Interaction between staff and residents was good and showed that staff were familiar with residents and their needs. Residents were observed moving around the home freely and being given choices about how to spend their day. Staff said choices were offered in areas such as meal times, bed times and rising and visitors said residents were able to make choices and to live the life they choose. The menus offered a choice of home made healthy and nutritious meals. Residents said they enjoyed the meals; comments included `they make sure we get enough to eat`, `there is always something to eat if you dont like what is on the menu` and `the food is very good`. Visitors also made positive comments about the meals. People were aware of the complaints procedure and told us that any concerns had been responded to properly. One visitor said `we have had no complaints over the last four years` and one resident said `Im happy here, I dont have any complaints`. The safeguarding procedures were clear and all staff had received training that would help them to recognise and respond appropriately to any signs or reports of abuse or neglect. Residents said there were enough staff available when they needed them and that staff listened to and acted on what they said. Residents and visitors made very positive comments about staff and it was clear they were happy with the care and attention they received. Comments from residents included `they look after me` and `they are nice staff`. Comments from visitors included `we have found the staff at Holme Manor to be very caring and friendly and helpful with regards to problems with mum`, `staff maintain positive attitudes`, `I am pleased to leave mum knowing she is in good hands`, `all the staff I have dealt with have been pleasant and helpful` and `the carers really care about residents welfare and comfort, nothing is too much trouble for them`. Staff had been provided with a range of appropriate training that would give them the skills and competencies to safely meet residents needs and most staff had a achieved a recognised qualification in care. Holme Manor was well maintained and safe and residents were provided with a range of aids and equipment to maintain their comfort and support and to promote their independence whenever possible. People were consulted about the day to day running of the home. What has improved since the last inspection? People were given clear information about Holme Manor to help them to decide whether the home would be a suitable place for them to live. Staff had collected useful information about residents routines, health, likes and dislikes and preferences; this would help staff to provide care in a more personal and individual way. A member of staff, responsible for planning activities and entertainments, had recently been employed; this meant that the provision of daily activities had started to improve since the last key inspection visit. Three residents said there were suitable activities for them to enjoy. Comments from visitors included `whenever I visit the staff are always taking an interest in what the residents are doing` and `mother only complains about one thing and that is boredom, I do feel they could try to occupy her more`. Visitors had been sent a copy of the complaints procedure which would help them to raise any concerns with staff and to reassure them that their concerns would be taken seriously. Staff had been provided with training to help them to deal with any difficult situations or challenging behaviours; there was some evidence of good practice in this area that would help to keep staff and residents safe. A number of residents at Holme Manor were sometimes unable to make decisions and choices for themselves; staff had received training to help them to make the right decisions and to understand their responsibilities. The home was well maintained, clean, bright and comfortable and any concerns raised at the last key inspection visit had been addressed. Bedrooms were comfortable and furnished to meet residents individual needs and most residents had brought in treasured items from home to help to make it more homely; one resident said she liked her room and said `it can never be like home but its the next best thing`. Other comments included `I have a very nice room` and `my room is cleaned and I have everything I need`. Staff had received training that would help them to understand the importance of good hand hygiene and to protect people from the risk of cross infection. New staff had all the proper checks completed before they started work; this would help to protect residents from unsuitable people. What the care home could do better: A copy of the service user guide should be available in each residents room or in the entrance hall so that people could refer to the information if and when they needed. The detail in the care plans did not always reflect the care that residents were receiving; they needed to include accurate information and sufficient detail to ensure staff had enough information to fully meet residents health and personal care needs. It was not clear whether residents and their relatives had been involved in the development and ongoing review of the care plans; their involvement would ensure they received the care that was both needed and wanted. The way in which residents medicines were managed needed to improve as some of the medication records lacked detail which meant there was potential for error. There should be clearer records to monitor whether everyones social needs and expectations were being met. The home needs to develop systems to monitor staff practice and compliance with policies and procedures; this would help to safeguard residents from the risk of abuse and neglect. There were serious concerns as records of residents personal monies were inaccurate which showed that residents finances were not managed in a safe way. Key inspection report Care homes for older people Name: Address: Holme Manor Care Home Holme Lane Holme Manor Townsend Fold Rossendale Lancashire BB4 6JB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 36 Information about the care home Name of care home: Address: Holme Manor Care Home Holme Lane Holme Manor Townsend Fold Rossendale Lancashire BB4 6JB 01706218953 01706830735 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Fallon Natalie Ann Godwin,Mr Ryan John Godwin care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP DE - Code DE The maximum number of people who can be accommodated is: 32 Date of last inspection Brief description of the care home Holme Manor Residential Care Home is registered to provide twenty-four hour care and accommodation for up to thirty older people who suffer from a dementia and for two older people. The home is situated in the Rossendale valley within easy access of the M62 and M66 Motorway network. Care Homes for Older People Page 4 of 36 Over 65 0 32 32 0 Brief description of the care home Holme Manor is an attractive stone built house in its own grounds. The home has thirty single bedrooms and one companion room on two levels which can be accessed via a passenger lift or stair lift. There are a number of shared toilets and bathrooms near to bedrooms and communal areas although most rooms have adjoining en-suites. Bedrooms are bright and airy with facilities for private telephones and lockable storage space. Communal rooms are furnished to a comfortable standard and decorated to suit the varied tastes of the residents. The conservatory extends the popular sitting area in the entrance hall. Information about services offered by the home is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their families. On the day of the inspection the weekly fees ranged from £388.00 to £463.00. Items not included in the fee include hairdressing, chiropody and personal toiletries. Care Homes for Older People Page 5 of 36 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: one star adequate 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 key unannounced inspection, including a visit to the home, took place on 19th January 2010. The last inspection on this service was completed on 20th May 2009 when the management were asked to send us a written plan of the action they intended to take to improve the home. The inspection process was undertaken by two Regulation Inspectors and included looking at records, a tour of the home, discussions with the registered provider (owner), two assistant managers, two care staff and three residents. The home sent us their annual quality assurance assessment (AQAA) before the visit; there were some gaps in the information although it gave us a reasonable picture of what had improved and where further improvements were needed. They also sent us a copy of their improvement plan; this was clear and showed us how Care Homes for Older People Page 6 of 36 they had responded to some of the concerns raised at the last key inspection visit. Information was also included from survey forms filled in by three residents and four visitors. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? People were given clear information about Holme Manor to help them to decide whether the home would be a suitable place for them to live. Staff had collected useful information about residents routines, health, likes and dislikes and preferences; this would help staff to provide care in a more personal and individual way. A member of staff, responsible for planning activities and entertainments, had recently been employed; this meant that the provision of daily activities had started to improve since the last key inspection visit. Three residents said there were suitable activities for Care Homes for Older People Page 8 of 36 them to enjoy. Comments from visitors included whenever I visit the staff are always taking an interest in what the residents are doing and mother only complains about one thing and that is boredom, I do feel they could try to occupy her more. Visitors had been sent a copy of the complaints procedure which would help them to raise any concerns with staff and to reassure them that their concerns would be taken seriously. Staff had been provided with training to help them to deal with any difficult situations or challenging behaviours; there was some evidence of good practice in this area that would help to keep staff and residents safe. A number of residents at Holme Manor were sometimes unable to make decisions and choices for themselves; staff had received training to help them to make the right decisions and to understand their responsibilities. The home was well maintained, clean, bright and comfortable and any concerns raised at the last key inspection visit had been addressed. Bedrooms were comfortable and furnished to meet residents individual needs and most residents had brought in treasured items from home to help to make it more homely; one resident said she liked her room and said it can never be like home but its the next best thing. Other comments included I have a very nice room and my room is cleaned and I have everything I need. Staff had received training that would help them to understand the importance of good hand hygiene and to protect people from the risk of cross infection. New staff had all the proper checks completed before they started work; this would help to protect residents from unsuitable people. 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 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 Care Homes for Older People Page 9 of 36 order line 0870 240 7535. Care Homes for Older People Page 10 of 36 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 11 of 36 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. People were given clear information about Holme Manor to help them to decide whether the home would be a suitable place for them to live. Detailed information was collected about prospective residents, before admission to the home, to help to determine whether they could be looked after properly. Evidence: The information about the home (service user guide and statement of purpose) had been up dated following the last key inspection visit. The information was clear and user friendly with photographs of the current staff which would help residents and their visitors to recognise who was who. The service user guide was given to prospective residents and their families but not easily available to current residents and visitors; the assistant manager said a copy of the guide could be provided on request and was available on the website. Residents and visitors said they received enough information about the home. However it was Care Homes for Older People Page 12 of 36 Evidence: recommended that the service user guide should be available in each resident room or in the entrance hall so that people could refer to the information if and when they needed. The information was not currently available in any other formats; the assistant manager said this could be developed in the future. Each resident, or their representative, was given a copy of the statement of terms and conditions or contract; this would help them to understand their rights and responsibilities during their stay at Holme Manor. New residents were not admitted to the home until detailed assessments of their needs had been completed by an experienced member of staff; this would help to decide whether Holme Manor was the right place for them to live. The information was obtained from a variety of sources including the resident, their family and friends and other professionals; this would help to ensure that all aspects of their needs were considered. The home needed to confirm, in writing and before admission, that peoples needs could be met; this would give them further reassurance that Holme Manor was the right place for them to live. People were encouraged to visit the home before they made any decisions to move into Holme Manor; this gave them the opportunity to meet residents, staff and to view the facilities. The training records showed that staff had the skills and competence to meet the needs of the current residents. Information from visitor and resident surveys confirmed this. Care Homes for Older People Page 13 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The detail in the care plans did not always reflect the care that residents received. Staff had access to clear medication procedures however some of the medication records lacked detail which meant there was potential for error. Evidence: Three residents care plans were looked at in detail. The management team said they had made some improvements to the care plans since the last key inspection visit. Residents and their relatives had provided staff with useful information about residents routines, health, likes and dislikes and preferences; this would help staff to provide the care that residents both needed and wanted. It was noted that the care plans did not always include accurate information or the amount of detail needed to ensure staff had enough information to be able to fully meet residents health and personal care needs. The care plans had been reviewed by the assistant manager each month based on Care Homes for Older People Page 14 of 36 Evidence: information provided by the care staff; the information was not always up to date and did not always reflect the current needs or action to be taken by staff to look after the resident properly which could result in residents needs not being met. It was unclear from the records whether residents and their relatives had been involved in the development and ongoing review of the care plans; this would ensure they were involved in decisions about the care being given. The registered provider had recently sent out a letter encouraging all relatives to become more involved in the reviews of care plans, one visitor had asked to be more involved in the care review and thought this had been well organised. Visitors said they were kept up to date with any changes and that their relative received the agreed support. Records showed that residents health was monitored and they had access to a range of health care services. Staff had received training in health care conditions which would help them to recognise and respond to any changes in residents health. The assistant manager said the nurse practitioner was very supportive and visited almost every day. A record of health professional visits had been maintained however one resident had needed antibiotics following an infection but there was no information in the care plan or daily report to support that staff had monitored or were aware of the residents condition. Residents had specific health conditions that were not reflected in the care plans; staff would be unaware how these conditions could impact on residents daily lives. Assessments were in place that would help staff to recognise and respond to any risks that would affect residents well being and safety. Appropriate action had been taken to protect those residents at risk of falling. Some of the risk assessments did not reflect the action being taken to reduce the risks and had not always been reviewed on a regular basis; this could result in residents changing needs not being recognised or met. Nutritional assessments were not included as part of the care plan. Residents were only weighed if they were fully mobile as there were no sit on scales; this meant that residents could be suffering from weight loss or gain without appropriate monitoring or action being taken. The registered provider advised that staff were due to attend training that would help them to identify any fluctuations in residents nutritional needs. Residents and their visitors were happy with the standard of care provided at Home Manor and it was clear from discussion and observation that residents needs were being met but there were concerns that this was not always reflected in the care Care Homes for Older People Page 15 of 36 Evidence: plans. The management team needed to develop a system to help them to monitor the content of care plans and to monitor whether staff were following policies and procedures (see standard 33 Management and Administration); this would help to improve records and to ensure staff had clear instruction as to the care that residents needed. Residents were provided with a range of aids and equipment to maintain their comfort and support and to promote their independence whenever possible. Staff responded in a friendly but respectful manner to residents and visitors to the home. Staff had received training to help them to understand the health and care needs of older people and to understand the importance of respecting peoples dignity and privacy. There were clear policies and procedures to support staff with the safe management of medicines. Staff had received in house training to help them to manage residents medicines safely and additional training was planned. Medicines were stored securely although some of the records were lacking in detail which could result in errors being made. There were a number of medication administration records (MARs) that were handwritten but had not been checked by a second member of staff; all handwritten entries should be witnessed to reduce the risk of mistakes being made. Some handwritten directions on the MARs did not match the instructions on the medicine packets or bottles as prescribed by the doctor; this could result in the medicines being given incorrectly at the wrong time or in the wrong way. There were gaps on the MARs where staff had not always recorded the reason to explain why medicines had not been given. One resident had not been given her prescribed medicines for two days as the medication was out of stock and had not been ordered, this was brought to the assistant managers attention and was immediately resolved. It was noted that two residents needed a thickening powder for their drinks as they had swallowing difficulties and staff were using the same tin; staff were reminded that residents should only use their own medicines as prescribed by the GP. Care Homes for Older People Page 16 of 36 Evidence: The management team advised that they did not have any medicines prescribed by a doctor that were to be given PRN or as needed; the use of these medicines would need to be supported by clear instructions and safe procedures. Controlled drugs records and stocks were checked and found to be accurate. The management team needed to develop a system to help them to monitor whether staff were following safe medication policies and procedures (see standard 33 Management and Administration); this would help to improve the medication records and to prevent any errors being made. Care Homes for Older People Page 17 of 36 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. Routines were flexible and the provision of stimulating and meaningful activities had improved, however records need to support that all residents recreational and social needs were met. Residents enjoyed a choice of nutritious and healthy diet that met their dietary needs and expectations. Evidence: A member of staff, responsible for planning activities and entertainments, had recently been employed; this meant that the provision of daily activities had started to improve since the last key inspection visit. A diary showed that activities were provided in house either in groups or on a one to one basis; it was recommended that there should be a record of the names of residents who participated in each activity as it was unclear whether everyones social needs were being met. Staff had started to collect useful information regarding residents choices, routine, likes and dislikes and preferences; this would help staff to make informed decisions and choices for residents who were unable to decide for themselves and would also help to provide more suitable activities and entertainments for them. Care Homes for Older People Page 18 of 36 Evidence: Newspapers were delivered to the home each day and staff were observed reading these with or to residents. Staff said they involved some residents in light cleaning tasks around the house or in folding table napkins and that one resident regularly sat with staff in the office. Residents also enjoyed the benefits of a house dog who roamed freely around the home. Three residents said there were suitable activities for them to enjoy. One visitor said whenever I visit the staff are always taking an interest in what the residents are doing and another said mother only complains about one thing and that is boredom, I do feel they could try to occupy her more. It was noted that residents seated in the main lounge were fairly active and were enjoying being entertained by staff, some residents sat in the conservatory quietly reading or napping whilst other residents sat at the dining tables chatting to visitors or each other; however residents in the quiet lounge seemed to be without staff interaction for periods of time and this was later discussed with management team. It was noted that any interaction between staff and residents was good and showed that staff were familiar with residents and their needs. Local community groups regularly visited the home; staff, residents and visitors were involved in fund raising for charitable organisations. Residents were observed moving around the home freely and being given choices about how to spend their day. Staff said choices were offered in areas such as meal times, bed times and rising and visitors said residents were able to make choices and to live the life they choose. Visitors were made to feel welcome and were able to visit in any area of the home. One visitor said I am always made welcome by the offer of a cup of tea. The menus offered a choice of home made healthy and nutritious meals. Residents said they enjoyed the meals; comments included they make sure we get enough to eat, there is always something to eat if you dont like what is on the menu and the food is very good. Visitors said the food is prepared fresh and I have been asked if I want to stay at lunch or teatime, the meals seem to be of a good quality and my mother seems to be able to get a drink of tea whenever she wants and the food is excellent. Residents had been consulted about the menus at the residents meeting and the chef and care staff were aware of residents dietary preferences; this would help to ensure that residents received meals that they enjoyed. There were records to support that residents had been offered alternatives to the Care Homes for Older People Page 19 of 36 Evidence: menu although it was recommended that a record of suppers was maintained to support that residents nutritional needs were met. Residents could dine in either of the dining rooms or in their rooms if they preferred; dining areas were bright and comfortable and tables appropriately set. The lunchtime meal was hot and appetising and residents said they had enjoyed it; staff gave residents the support they needed and mealtimes were unhurried. Care Homes for Older People Page 20 of 36 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. People were protected by staff awareness and safe policies and procedures. Evidence: The complaints procedure was clear and advised people what to expect when they raised their concerns. Following the last key inspection visit all relatives had been sent a copy of the procedure; this would help people to raise any concerns with staff and to reassure them that their concerns would be taken seriously. The complaints procedure was included in the service user guide; a recommendation had already been made to make this more easily accessible as a point of reference to existing residents and any visitors to the home (see Choice of Home outcomes). The complaints record was viewed; the records showed there had been no complaints since the last inspection visit. Surveys indicated that people were aware of the complaints procedure and that any concerns had been responded to properly. One visitor said we have had no complaints over the last four years and one resident said Im happy here, I dont have any complaints. The safeguarding procedures were clear and all staff had received training that would help them to protect residents from harm by recognising and responding appropriately to any signs or reports of abuse or neglect. Care Homes for Older People Page 21 of 36 Evidence: Since the last key inspection visit, staff had been provided with appropriate training to help them to deal with any difficult situations or challenging behaviours; there was some evidence of good practice in this area that would help to keep staff and residents safe. There were procedures to support staff to report any incidents of poor practice within the home; this would help to protect residents from harm. A number of residents at Holme Manor were sometimes unable to make decisions and choices for themselves; staff had received training to help them to make the right decisions and to understand their responsibilities. Staff said this training was interesting and informative. There were procedures in place to support staff with safe management of residents personal monies; however from a review of residents records it was clear that safe procedures had not been followed (see Management outcomes). Care Homes for Older People Page 22 of 36 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. People lived in a safe, comfortable and well maintained home that met their individual needs. Evidence: A tour of all areas of the home was undertaken. The home was well maintained, bright and comfortable and any concerns raised at the last key inspection visit had been addressed. A handyman was responsible for day to day repairs and maintenance and there were systems in place to ensure he was notified of any work needing to be done. It was advised that any requests were recorded in a book by staff and the work was signed off when completed; this would help to ensure all work was recorded and responded to promptly. There was no formal development plan to support ongoing improvement although management, staff and some residents were able to discuss the recent improvements and further work that was planned. The building complied with recommendations made following visits from the fire safety officers and environmental health officers. Work was due to commence to improve office areas in line with fire safety legislation and records had been introduced to support safe kitchen practices. Care Homes for Older People Page 23 of 36 Evidence: Garden and patio areas were safe, accessible and attractive; seating was available for residents and their visitors to enjoy the gardens in the warmer months. One visitor said the outside access has been improved and another said the garden at the top is underused. Communal areas were comfortably furnished, bright and airy. Residents and their visitors were able to choose where they preferred to sit and chat; they could meet in the lounge or dining areas or meet in private in one of the quiet seating areas or in their bedrooms. Lounges were fitted with sound systems that would help residents that suffered from hearing difficulties and large screen televisions to help those residents with poor sight; this supported that consideration was given to residents needs. Suitably equipped lavatories and bathrooms were located near to communal areas and were clearly signed; most of the bedrooms were provided with en suite facilities which helped to ensure residents privacy and dignity. Work was underway to improve one of the bathrooms and provide easier disabled access. Aids and adaptations were provided in all areas of the home to ensure residents safety and comfort and to help them to maintain their independence where possible. Wheelchairs were stored safely and were used with foot plates intact, this would help to protect residents from injuries from incorrect use of equipment. Call alarm systems were provided in every room to enable residents to call for assistance from staff when needed. Bedrooms were comfortable and furnished to meet residents individual needs. Most residents had brought in treasured items from home to help to make it more homely; one resident said she liked her room and said it can never be like home but its the next best thing. Other comments included I have a very nice room and my room is cleaned and I have everything I need. The home was clean and tidy; there was a dedicated team of laundry and domestic staff. There were no unpleasant odours other than in one bedroom; the manager advised that the carpeting was due to be replaced with more suitable flooring. Staff had received training that would help to protect people from the risk of cross infection. Care Homes for Older People Page 24 of 36 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. The staff team was suitable, competent and provided in sufficient numbers to meet residents needs. Evidence: The staff rota showed there was sufficient staffing to meet the needs of the current residents. Residents said there were enough staff available when they needed them and that staff listened to and acted on what residents said. The turn over of staff was low and ensured residents would be cared for by a stable team of staff who knew them well. People made very positive comments regarding staff and it was clear they were happy with the care and attention they received. There were a number of thank you and compliments letters and comments included thanks to the staff for your support, thank you for your caring and your help and Holme Manor is delightful. Comments from residents included they look after me, the staff are very lively and they are nice staff. Comments from visitors included we have found the staff at Holme Manor to be very caring and friendly and helpful with regards to problems with mum, staff maintain positive attitudes, I am pleased to leave mum knowing she is in good hands, all the staff I have dealt with have been pleasant and helpful and the carers really care about residents welfare and comfort, nothing is too much trouble for Care Homes for Older People Page 25 of 36 Evidence: them. There were clear recruitment procedures in place. Three staff files were looked at in detail and showed that new staff had been recruited safely and that all checks were in place before they started work; this would help to ensure residents were protected from unsuitable people. Management were advised to implement a checklist which would help to organise staff files and to easily identify whether all the required checks were in place. References had been checked before new staff had started work but should always be sought from the previous employer or the reasons for not obtaining one should be recorded on the staff file. References should always be directed to the registered provider or manager and not to whom it may concern. New staff had received an introduction to the home to ensure they were aware of the routines of the home, the needs of the residents and were safe to practice. The home had a dedicated training manager and access to a training room located away from the home. There was an overall training plan and individual staff training plans which showed that all staff had been provided with a range of appropriate training that would give them the skills and competencies to meet residents needs. Records showed that training needs were discussed in regular one to one supervision sessions; this would help to identify whether any additional training and support was needed. Staff meetings were held at regular intervals to help keep them up to date with any changes and to give them the opportunity to raise their views and opinions. Care Homes for Older People Page 26 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Holme Manor was well maintained and safe and people were consulted about the day to day running of the home. Records did not always support that residents finances were safeguarded. Evidence: The structure of the management team had changed since the last key inspection visit. The registered provider (owner) Mr Ryan Godwin is currently making an application to register as manager with the Care Quality Commission; this means he will be responsible for the day to day management of the home. He is currently working towards a management and care qualification that will give him the required qualifications and competencies to run the home. Mr Godwin is currently supported by two assistant managers; one assistant manager has a relevant management and care qualification and one is working towards achieving a relevant qualification. The staff team were safely recruited and provided with a range of training to help them to meet current residents needs. There was supporting evidence that the service Care Homes for Older People Page 27 of 36 Evidence: worked well with families and friends and visiting professionals; this would help to ensure residents needs were met. Staff had access to a clear on call procedure if they needed help and advice out of hours. The management team had responded to concerns that were raised at the last key inspection visit in May 2009 and had supplied us with an improvement plan; this showed that the home was committed to improving outcomes for people who lived at Holme Manor and were willing to work with us. From discussions and looking at records it was clear that the management team were committed to continuously improving the service, providing an increased quality of care for residents and ensuring peoples needs and expectations were met. Also from surveys and discussions it was clear that people were happy with the service they received; one visitor said the service is first class. The home sent us their annual quality assurance assessment (AQAA) prior to the inspection visit; there were some gaps in the information although it gave us a reasonable picture of what had improved and where further improvements were needed. The management team had developed different ways of consulting people about how the home was run; this would help them to improve the home. Visitors meetings had not been arranged although the registered provider had sent out a newsletter to residents families and friends to keep them up to date and informed. The residents committee met in September last year and were due to meet again this month; currently only a small number of residents were able to participate. An annual survey had been sent out to residents and any visitors to the home to seek their views on whether they were happy with the service; the provider was advised that the information needs to be analysed and the results made available to people. The registered provider said he had used the information from the surveys to identify any shortfalls and to improve the service. The home has achieved the Investors In People award; this is a recognised quality accreditation that looks at how the home is managed and the standard of training and development of staff. The information from the assessment had been used to improve the service. Policies and procedures were clear and had been reviewed to provide staff with current safe guidance; a further review was due to take place. Staff were provided Care Homes for Older People Page 28 of 36 Evidence: with a handbook that included the key policies and procedures and could be referred to if staff were unclear about any aspect of their work. Management needs to develop systems that would help them to monitor staff practice and compliance with policies and procedures and to safeguard residents from the risk of abuse and neglect. There were checks in place to monitor catering and financial records although there were none to monitor the content and quality of care plans or the safe management of medicines. The home managed a small amount of money for a number of residents; money was stored securely but there were concerns as the records of residents finances were inaccurate. Three residents personal allowance records were looked at in detail to check whether residents monies were safeguarded. One record showed an accurate balance but further investigation showed that the records were inaccurate and did not correspond with the hairdressers list; two other records were not up to date following a chiropody visit in December as the record sheet did not tally with the amount of cash held in the safe. The chiropodist or the hairdresser had not provided receipts so it was difficult to audit and there was no record, other than a small piece of paper, to support treatment from the chiropodist; this was discussed with the registered provider and he agreed that these systems would be reviewed and ensure receipts would be obtained. As mentioned previously some records such as the care plans, financial and medication records were not always accurate or up to date; this meant that staff may not have been aware of important aspects of the residents welfare. Records were sampled and showed that equipment and systems were safe as they were regularly serviced and maintained. All staff had received regular safety training to keep themselves and others safe. Care Homes for Older People Page 29 of 36 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 30 of 36 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 14 The care plans must include 19/03/2010 accurate and up to date information and sufficient detail. Issue date 19 January 2010. Timescale by 15 March 2010. This will ensure staff have enough information to be able to fully meet and understand residents health and personal care needs. 2 8 13 Risk assessments must 19/03/2010 reflect the action being taken to reduce or eliminate risks and must be regularly reviewed based on the level of risk. Issue date 19 January 2010. Timescale by 15 March 2010. This will ensure that residents changing needs can be recognised and met. Care Homes for Older People Page 31 of 36 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 3 8 13 Residents nutritional status 19/03/2010 must be assessed on admission and at appropriate intervals dependent on the level of risk. Issue date 19 January 2010. Timescale by 15 March 2010. This will help to identify those residents at risk of health problems associated with a poor dietary intake. 4 9 13 Handwritten directions on 19/03/2010 the medication administration records must match the instructions given by the doctor. Issue date 19 January 2010. Timescale by 15 March 2010. This will reduce the risk of medicines being given at the wrong time or in the wrong way. 5 9 13 Staff must ensure residents 19/03/2010 always have sufficient stocks of medication. Issue date 19 January 2010. Timescale by 15 March 2010. This will ensure residents receive their medicines as prescribed by the GP. Care Homes for Older People Page 32 of 36 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 6 9 13 Staff must follow safe 19/03/2010 procedures and ensure medicines are given only to the resident they have been prescribed for. Issue date 19 January 2010. Timescale by 15 March 2010. This will help to reduce the risk of error. 7 33 13 The service must develop 19/03/2010 systems to monitor staff practice and compliance with policies and procedures. Issue date 19 January 2010. Timescale by 15 March 2010. This will help to identify any shortfalls and to safeguard residents from the risk of abuse and neglect. 8 35 17 Records of residents 19/03/2010 personal monies must be up to date and accurate and receipts kept. Issue date 19 January 2010. Timescale by 15 March 2010. This will help to ensure residents finances are safeguarded. 9 37 17 The registered person must 19/03/2010 ensure that records required by regulation for the Care Homes for Older People Page 33 of 36 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 protection of residents and the effective efficient running of the service are maintained, up to date and accurate. Timescale of 21 May 2009 not met. Issue date 19 January 2010. Timescale by 15 March 2010. Records are required for the protection of residents and the effective efficient running of the service. 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 1 1 The service user guide should be made available, with a copy of the last key inspection report, to existing residents and visitors; this would help them to understand their rights and responsibilities and be available to use for a reference. The home should confirm, in writing and before admission, that peoples needs can be met; this would give them further reassurance that Holme Manor was the right place for them to live. The care plans should reflect that residents and their relatives have been involved in the development and ongoing review of the care plans; this would ensure they are involved in decisions about the care being given All handwritten directions on medication administration records should be witnessed by a second member of staff; this will help to reduce the risk of mistakes being made. 2 2 3 7 4 9 Care Homes for Older People Page 34 of 36 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 5 9 The reasons for non administration of medicines should be recorded; this will help to monitor whether residents are receiving the correct treatment and will help to reduce the risk of errors. There should be a record of residents who had participated in daily activities; this would help to identify whether everyones social needs were being met. The records of meals served should be extended to include a record of suppers to support that residents received meals at regular intervals. References should always be sought from the previous employer or the reasons for not obtaining one should be recorded on the staff file and should always be directed to the registered provider or manager and not to whom it may concern; this will ensure that the registered person has full and detailed information about applicants. The application to register a manager with the Care Quality Commission should be completed. Information from the surveys should be analysed and made available to service users and visitors to the home; this will help to reassure people that the service has listened to them and is responding to their suggestions. 6 12 7 15 8 29 9 10 31 33 Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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