Care Home: Holmewood EMI Resource Centre

What the care home does well What has improved since the last inspection? There were six requirements following the last inspection. The home has made good progress dealing with these requirements and in line with our revised national policy two have been carried forward as recommendations. The home has worked hard to improve the care records to help make sure that care is given in a way that takes account of people`s abilities and preferences. Improvements have been made to the way people`s social care needs are dealt with. This means that people are getting more support in following their personal interests and making the most of their abilities. One person we spoke to said they had seen a lot of improvements over the past 12 months and another said, "I feel the home has settled down now there are regular staff on duty". There has been an improvement in staff training, which means that staff have a better understanding of the needs of the people they are caring for. The manager has successfully completed the process of registration. This means that people can be confident she has the right skills and experience to manage the home. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Holmewood EMI Resource Centre 67 Fell Lane Keighley West Yorkshire BD22 6AB Lead Inspector Mary Bentley Unannounced Inspection 14 & 15 October 2008 1:00pm X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmewood EMI Resource Centre Address 67 Fell Lane Keighley West Yorkshire BD22 6AB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01535 602997 01535 691095 selma.inman@bradford.gov.uk City of Bradford Metropolitan District Council Department of Social Services Selma Patricia Inman Care Home 32 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (30) of places Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2007 Brief Description of the Service: Holmewood Resource Centre is situated in a residential area of Keighley about one mile from the town centre. The home is on a main bus route and parking is available at the front of the property. The home is run by Bradford Social Services and provides permanent and short-term care for people with a diagnosis of dementia or a dementia type illness. The resource centre also has a day centre and an outreach service; this inspection only looked at the residential services. Accommodation is provided on two floors, in four separate units, 3 are long stay and one is for respite (short term) care. Each unit has a communal lounge/dining room, and toilet/bathroom facilities are conveniently located throughout the building. A ramp provides disabled access to the front door. The home has a passenger lift to the first floor. The home stands within its own grounds and there is a sensory garden which is easily accessible to people. In October 2008 the weekly fees ranged from £102.00 to £435.00. Hairdressing and chiropody are available at an additional cost. Copies of inspection reports are included in the Statement of Purpose, which is available on request from the home. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The inspection process included looking at the information we have received about the home since the last key inspection in October 2007. This inspection was carried out over 2 days; the first day of the visit was unannounced and over the 2 days we spent approximately 9.5 hours in the home. Since the last key inspection in October 2007 we have made one additional visit to the home in February 2008. The purpose of the visit in February was to look at concerns about staffing and the experiences of people living in the home. The report from that visit is available on request. The purpose of this visit was to look at how the home is meeting people’s needs and to check if the requirements made at the last inspection have been dealt with. During the visit we spent time observing how people are cared for, we spoke to visitors, staff and management, looked at various records and looked around the home. Before the visit we sent surveys to people using the service, health care professionals involved with the home and staff. In total 15 were retuned. We asked the home to complete a self-assessment form (AQAA); this was returned to us in good time and gave us all the information we asked for. What the service does well: These are some of the comments we received from relatives of people living in the home: Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 6 • • • • • “ I have always found the staff welcoming and whenever I go to the home, whatever time of day, I have never felt unwelcome” “I feel that adequate care is taken of my mother” “The premises are kept spotlessly clean” “My mother and I feel that the care my father receives at Holmewood is extremely good” “Holmewood looks after my mother very well, it is a very friendly place” What has improved since the last inspection? What they could do better: We asked people what the home could do better, one person said, “I think the staff/client ratio could be better” and another said “Maybe a few more activities”. In the self-assessment, which the home completed for us, they told us they have identified a number of areas where they plan to continue to make improvements. These include: • improvements to the care records to reduce the risk of people’s needs being overlooked • improvements to the way people’s social care needs are met and in particular giving people more opportunities to take part in activities outside the home and • improvements to the environment to make it more enabling for people. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 5. Standard 6 does not apply. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People or those close to them are given information about the range of services offered, they are encouraged to visit, and their needs are assessed before they move in. EVIDENCE: The manager explained that they prefer people to come and spend a day at the home before making a decision about moving in. This gives people the opportunity to see what the home is like and to meet the people who live and work there. If this is not possible the manager will visit people to find out about their needs before offering them a place. Many of the people who move in permanently have attended the day centre or stayed in the short stay (respite) unit and therefore are familiar with the Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 10 home. The fact that they are familiar with the setting and some of the staff usually helps people to settle in. When someone is referred for long term care a panel of senior staff decides if the home will be able to meet that person’s needs. The home records all discussions and decisions about whom they can or cannot offer a place to and this allows them to show they are operating an equal opportunities admission policy. This is good practice. The majority of relatives who completed our surveys said they had been given enough information about the range of services offered. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s health and personal care needs are met. The home is continuing to improve the care records to make sure they accurately reflect the care people are receiving and to reduce the risk of people’s needs being overlooked. EVIDENCE: These are some of the comments we received from relatives of people living in the home. • “The staff have also let me involve myself fully and I have never felt I couldn’t do things for my Mum as I have been involved in her care for many years it was important to me to keep that contact with her” “Holmewood looks after my mother very well.” • Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 12 Other people told us they are satisfied that the home gives their relatives/friends the care they need. Most people said the home keeps them informed about changes in their relatives care needs. The manager told us that over the past year the home has been working hard to improve the care records but she is aware that more works needs to be done in this area. The home is continuing to provide training for staff to make sure that the records are kept up to date and give an accurate picture of how people are cared for. We looked at the care records of 3 people living in the home. The care records have information about people’s personal, health and social care needs. People’s needs are assessed and care plans are in place where necessary to show how these needs will be met. Areas of risk are identified, for example there are risk assessments for nutrition, falls and pressure sores. Individual risks such as smoking are also assessed. We saw that people have access to NHS services such as GPs, district nurses, and chiropodists. There are suitable systems in place to make sure that people’s medicines are managed safely. Most of the staff have completed a training course on the safe management of medicines. The records we looked at were satisfactory. People looked clean and cared for and we saw that staff are kind and treat people with respect. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are supported in making the most of their abilities and are given the opportunity to take part in a range of social activities, which take account of their preferences and abilities. EVIDENCE: We saw information in the care records about people’s past lives and interests. There is a list of planned activities in each unit and the home has been working hard to improve this aspect of the service. For example, they are now making more use of the day centre at evenings and weekends to hold social events for people living in the home. The home organises fund raising events to provide extra money for social events such as entertainers and trips out. Throughout the visit we spent time in the lounges observing what interaction and activity staff had with people living in the home. We saw that people are at ease in the environment and are able to walk around freely between the different lounge areas. Some people went to the Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 14 day centre to join activities there. Activities are organised on the units for people who are unwilling or unable to go to the day centre. For example we saw staff giving people hand massages, encouraging people to sing along to music and reading newspapers with people. We saw that some of the ladies are supported in doing things they would have done at home, such as setting tables and washing up. We saw that staff are attentive to people’s needs and have a genuine concern for people’s welfare. They were particularly attentive to one lady who had recently been unwell. They spent a lot of time encouraging her to drink and staff that were working in other parts of the home popped in to see if she was getting better. The hairdresser was in the home during our visit. We saw various staff make repeated efforts to persuade one lady to have her hair done but despite their patience and persistence she continued to decline. We heard staff complimenting people on their appearance when they had been to the hairdresser and saw that people responded positively to this. We saw one or two examples of missed opportunities, where staff did not pick up on signals that people needed help. For example, on one occasion staff did not recognise that someone was looking for the bathroom and this resulted in some unnecessary distress. This was discussed with the manager. Visitors told us they are always made welcome. We observed the lunchtime meal being served on one unit. The mealtime was calm and well organised. Staff sat and had their meal with people and where necessary they prompted and helped people discreetly. A visitor had lunch with their relative while helping them to eat. Everyone said the food was good and they complimented the chef on his food and presentation. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are suitable systems in place to make sure that complaints are dealt with appropriately and people are protected from abuse. EVIDENCE: Bradford Social Services has a detailed complaints procedure and there is a central complaints officer who deals with complaints that cannot be resolved by the home. Information about the complaints procedure is displayed in the home and is included in the Statement of Purpose and Service User guide. The home told us they have had 9 complaints in the past year and 90 of these were dealt with within 28 days. Five of the six relatives who completed our surveys said they know how to make a complaint and the majority said the home always responded appropriately to concerns. We received one complaint about the service; this was sent to the home and was dealt with by them. All the 5 staff that completed our surveys said they know what to do if anyone has concerns about the service. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 16 The home has procedures in place to make sure people are protected and all staff have attended training on the protection of vulnerable adults. Last year a number of concerns were referred to the Adult Protection unit. These have all been dealt with and the home has taken action to reduce the risk of similar problems happening in the future. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is clean, tidy, and comfortable. Some improvements have been made but more work is needed to make sure the environment supports people with dementia to make the most of their abilities. EVIDENCE: The home was clean when we visited and people told us it is always clean. The four self-contained units help to create a homely environment. The internal layout of the home lets people walk around without coming up against too many barriers and sitting areas have been provided where space permits. There is a secure garden where people can walk around or sit and enjoy the day, weather permitting. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 18 When we visited last year we identified that improvements were needed to the environment to make it more suitable for people with dementia. The manager told us that discussions are taking place about a complete refurbishment but a date has not yet been agreed for the work to start. However, in the meantime some improvements have been made. For example photographs of people taking part in activities and outings have been put up on the corridors on the ground and first floor. The manager said this has been very successful and has given people a focal point and encouraged conversation. Photographs have also been put on bedroom doors and staff said this has made it easier for people to find their own rooms. The home has also created a seating area in the conservatory, which people can use when they have visitors or when they just want somewhere quiet to sit. When we last visited we were concerned that all bedroom doors were locked during the day meaning that people could not have access to their bedrooms. The manager told us this policy has been reviewed and although many people still choose to have their doors locked decisions are now made on an individual basis. There are appropriate systems in place to reduce the risk of cross infection. One visitor commented that the laundry is very good and said her relatives personal clothing is kept in good condition. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff available to make sure people’s needs are met and staff are supported in developing the skills and knowledge they need to care for people properly. People are protected because all the required checks are completed before new staff start work. EVIDENCE: These are some of the comments made by relatives of people living in the home. • “ I would just like to say how caring the staff are, and always keep us informed about his health and wellbeing.” • “There have been staff from an agency working sometimes and I have found they are good and know what they are doing” • “I always find my Mum less anxious when there are care staff on duty who do sit and talk with them as this seems to have a calming effect” When we visited last year the home was having a lot of staffing difficulties however this has now improved. The majority of relatives told us they have seen improvements over the past 12 months and said there are now more regular staff on duty. They said they think consistency is important and that Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 20 people receive better care from staff that know them. One relative told us they think there is still more to be done in this area and expressed concern about the use of agency staff. Staff said there are usually enough of them on duty to meet people’s needs. Staff also told us they are supported by the management team and get the training they need to help them understand and meet people’s needs. When asked what the home does well one member of staff said “looks after service users very well, the home also looks after the staff if they need it”. The home has recently appointed 2 new senior care assistants, there are still some vacancies for senior care staff, and the home is working on recruitment. The home has reorganised all the staff files so that all the required information is available and easy to find. The files we looked at showed that all the required checks are completed before new staff start work. The training department (workforce development unit) supports the home in providing training for all staff. All new staff have a detailed induction, which includes training on safe working practices. When staff have completed their induction there is an expectation that they will go on to do an NVQ (National Vocational Qualification) in care. At present over 60 of staff have achieved this qualification and other staff are working towards it. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are suitable arrangements in place to make sure that the home is managed properly. The home provides a safe place for people to live and work. EVIDENCE: The home manager has successfully completed the registration process since our last visit. There is a corporate annual quality development plan and most of this has been implemented at Holmewood. For example, there are regular meetings Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 22 for people using the service, an external quality visitor visits once a month and the home has links with the local branch of the Alzheimer society. When people come for respite care they or their families are sent a questionnaire, which gives them the opportunity to have their say about the service they received. Questionnaires have also been developed for people receiving long-term care and have just been sent out. The feedback from these surveys will help the home to identify areas of good practice and areas where improvements are needed. The home holds staff meetings and staff have appraisals and supervision. Some staff that completed our surveys said they would like more unit meetings and the manager agreed that this is an area that could be improved. The home manages personal money on behalf of some of the people living there. There are suitable systems in place to make sure that people’s financial interests are safeguarded and that people can have access to their money when they want it. Information provided by the home showed that there are suitable systems in place to protect the health and safety of the people who live and work there. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001, and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP19 Good Practice Recommendations Work should continue on improving the care plans to make sure that people’s needs are not overlooked. The planned refurbishment should take into account the needs of people living in the home and particular attention should be given to how the environment can be made more enabling for people with dementia. Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Holmewood EMI Resource Centre DS0000033522.V372788.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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