Care Home: Holmwood Residential Home

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What the care home does well Holmwood is tastefully decorated, comfortable and well maintained. The atmosphere was warm and friendly, and visitors and friends are made to feel welcome. Some of the residents told us, `All in all this is a good home. I find the staff are very pleasant`, or `the best thing is the pleasant surroundings and the good staff`, or `we are very well looked after`. The home provides flexible routines so enables residents to exercise choice and control over their preferred lifestyle. This includes opportunities for the residents to access leisure activities and entertainment, and opportunities for contact with the local community. Residents are supported by a professional, well trained, and a hard working staff group, who are qualified and able to meet their care and support needs. Staff provided care to the residents in a respectful and dignified way. There is a strong management commitment to providing residents with a quality service, evidenced by an appropriate management structure, sound quality assurance systems, and a supportive staff group. The home showed us they have robust recruitment and selection processes in place, which would protect the residents. The health and care support received was good. Medication processes were very comprehensive, which would ensure that residents` received their medicines as prescribed. What has improved since the last inspection? At the last inspection, three key areas for improvement had now been resolved by the home. These included improvements to the medication processes, the provision of behavioural support plans, and addressing concerns around uncovered radiators. The home also told us that improvements have been made by including palliative care documents within the residents` care plans, and that they are now more proactive at assessing and reviewing their overall practice. What the care home could do better: The home showed us that they continue to provide a quality service that met the needs of the residents. The hot water tap temperatures of some hand washbasins were found to be excessive at the time of the inspection. A further visit to the home showed us that appropriate measures had been taken to address these concerns, including improved monitoring of the temperatures. Soft diets for some of the residents could be improved by ensuring constituent parts are separated for their enjoyment. Residents would benefit from a revised menu plan that includes a second hot meal menu choice, and improved menu records would show how the home meet each resident`s individual meal choices and options. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmwood Residential Home 37 Upper Olland Street Bungay Suffolk NR35 1BE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevin Dally     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Holmwood Residential Home 37 Upper Olland Street Bungay Suffolk NR35 1BE 01986892561 01986896030 sandra@holmwood-bungay.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Nicholas John Willoughby Sheldrake Name of registered manager (if applicable) Mrs Sandra O`Grady Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is: 32 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Holmwood has registered places for a total of 32 people who are elderly or have a diagnosis of dementia. It is situated in the small market town of Bungay. The home was formally the Holy Trinity Rectory and was purchased by the Sheldrake family in 1977. The original building has been significantly extended twice since 1992. Care Homes for Older People Page 4 of 33 care home 32 Over 65 0 32 32 0 Brief description of the care home During the last few years a programme of refurbishment has taken place providing a well maintained, attractive and comfortable home whilst retaining a lot of its old charm and period features. The home is set in well cared for gardens and is close to local shops and amenities. A detailed statement of purpose, colour photographic brochure and a service user guide provides detailed information about the home, the services provided and access to local services. Each resident has a contract of terms and conditions; which reflect the fees and how much they are expected to pay per month. Fees are calculated depending on the needs of the resident and range from £440 to £600 per week. Care Homes for Older People Page 5 of 33 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: three star excellent 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: This was a key unannounced inspection of Holmwood Care Home, which took place on the 11th December 2008. Ms Sandra OGrady the manager provided us with information that was relevant to the inspection. We were able to spend time with a number of the residents and spoke with some of the staff group. This gave us information about the home including what people thought about the quality of the service provided. We also observed staff serving the lunch, and we followed a medication round. A selection of residents care plans and medicine records; staff records, maintenance and training records were also checked, as were a selection of other documents, including the staff duty rotas and the residents menu. Care Homes for Older People Page 6 of 33 Surveys were sent to the home to distribute to residents, relatives and staff before the inspection took place. Seven residents, 2 relatives and 7 staff members responded to our questions. A selection of their views and opinions about the home are included within this report. A further site visit was undertaken on the 23rd January 2009 to confirm that the provider had addressed our concerns around hot water tap temperatures. The manager also completed the CSCI annual quality assurance assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 10 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents can expect to receive detailed information about the service, and have their needs assessed prior to commencing their stay in the home. Evidence: The information provided by the service (the AQAA) informed us that the home continued to provide information for the residents including a residents guide. They said, All prospective users are offered a variety of information to enable them to make an informed choice about where they would like to live. Families and social services (where applicable) are encouraged to take part in this decision process. All clients are given a brochure (menus and entertainment schedules) which details the service that we offer and what clients can expect. All clients are given a tour of our facility and are encouraged to either stay for lunch/supper or to come back on another day of their choice. In some cases some clients have visited again to join in the entertainment. During the visits they are encouraged to meet with other residents and talk in private. Care Homes for Older People Page 11 of 33 Evidence: We also encourage clients to take the leaflets regarding an independent advocacy service which can advise them about a whole host of matters relating to deciding what kind of care package to choose. The home also told us, We offer our brochure and new residents welcome brochure in CD format for those poeple who might have sight difficulties. The home maintained a detailed statement of purpose which was available for the residents to read. Feedback received from 6 of 7 residents said they had received sufficient information about the home before they had moved in. One did not say. Two residents care plans were checked to assess the level of assessment that was undertaken by the home, to record the residents level of care and support. Each resident had a detailed daily living and needs assessment profile in place, which staff could refer to. These assessments included around 11 separate areas of assessment with sections on personal and physical well being, communication needs, personal safety, medicines required and dietary needs, among others. Feedback received from 7 of 7 staff members told us that they are always given up to date information about the needs of the people they provide care and support for. The staff we spoke with demonstrated a good knowledge of the care and support needs of the elderly residents at the home. One example was a support worker was observed positively supporting two residents with dementia, and supporting them with their meal. This included talking with them about their past, and reference to their friends and family who visit. The home showed us that the staff group had received comprehensive training, (please refer to standard 30) so that their knowledge, care skills and experience was suitable to meet the needs of people who are elderly or have dementia. One example was that a member of staff had received dementia care training at Otley college. The home also ensured that new staff were thoroughly inducted, and feedback received from 7 staff members all confirmed that their induction covered everything they needed to know to do the job, when they started. Information provided by the home told us that 12 of 16 support care staff (75 percent ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 8 working towards an NVQ 2 or higher care qualification. (Please refer to staffing outcome area). Residents records checked provided a welcome pack with information that included a detailed written contract with the terms and conditions of residence, a welcome letter, a brochure about the service, a record of clothes brought to the home, and an admission check list. Feedback from 7 residents told us they had all received a contract of the terms and conditions of the home. The home does not provide intermediate care so this standard is not applicable. Care Homes for Older People Page 12 of 33 Care Homes for Older People Page 13 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive well-planned care, which meets their health care and support needs. Care will be provided in a dignified way. Evidence: Two residents care plans were checked. The front section included a front sheet, a photograph of the resident, and their personal details including next of kin and other key information. Part two of the plan was divided into 12 sections, each of which covered all aspects of the residents health, personal and social care needs. Areas included the residents medical history, medication, communication, mental health, psychological and social needs, mobility, physical needs, diet, continence care, dental care, religious preferences, and social activities. Each area provided guidance for staff around the care to be provided and the reason for care. The care format was detailed, but very clear and explained exactly what staff needed to know to provide good support for the resident. One resident with dementia was tracked and the recommended support advice in the care plan around Care Homes for Older People Page 14 of 33 Evidence: communication, diet and psychological support was observed being fully followed by staff. The care plans were supported by various risk assessment documentation including moving and handling risk assessments, individual risk assessments, falls and pressure care monitoring. Care plans were dated and noted as having been reviewed on a regular basis. Daily care records were provided and showed us that each residents daily care and support was being recorded and monitored. One area for improvement would be around the provision of life stories for the residents, particularly for more vulnerable residents, for example those with dementia. This would enable each residents social background, his or her preferences and choices to be more fully described, and care delivered with this in mind. The information provided by the home told us The managers continue to review the amount of falls that we have at Holmwood (care assistants complete the falls monitoring chart that is kept in each residents care plan) and this information is entered into a summary of falls chart, so that we can review our progress against the action taken to try and minimise the falls. A check of the homes accident records for the previous 6 months (May to Oct 2008) showed us that falls are closely monitored. Records are also kept in each residents file, and this would show any trends or concerns. One resident who had experienced a high number of falls in one month had been referred to the falls advisor, reviewed by the general practitioner and an action plan put in place, to try to reduce these incidents. The previous inspection identified the value in maintaining a record of any residents who became verbally or physically aggressive. Positively in one residents records, it was noted that a behaviour pattern and observation sheet was in place and being used. This provided management with an insight of any occurrences, and the events that may have triggered particular types of behaviour. The record also included how staff how resolved each particular behavoural episode. One residents care plan checked provided the details of their end of life needs to assist staff to prepare for any arrangements, and support of their relatives. There was a record of visits by healthcare professionals including the general practitioner (GP) and district nurse. Feedback from 7 residents told us that they always received the care and support they needed, and always or usually receive the medical support that they needed. A group of residents spoken with told us that they were very happy here, and felt very well looked after. The residents also said that the staff group were pleasant, well presented, and always willing to help. Care Homes for Older People Page 15 of 33 Evidence: The information provided by the home (AQAA) said, Each month the manager and assistant manager extensively review the medicines procedure and medication administration record (MAR) sheets which is documented via the managers report and each senior care assistant is given a monthly copy of this report. The home uses the monitored dosage system (MDS) with blister packs and MARS sheets, including each residents details and a photograph of the resident, for identify purposes. Medicines are kept locked in the medicine trolley, which the staff take to the residents. The lunchtime medication round was observed and the medication administration records (MAR) sheets were checked, and three residents medicines were audited. The senior carer signed the MAR sheets appropriately after medicines were administered and no signature gaps were noted on the MAR sheets. Records checked showed us that the home used non administration codes to identify if a resident refused any medicines. There were individual records for the medicines provided from individual medicine packets, which was very good practice. An audit of three residents medicines showed us that the records were correct and accurate. The home confirmed that there was medicine guidance around the control, storage, disposal, recording and administration of medicines, although this was not checked on this occasion. One care coordinators records checked showed they had received safe handling of medicines training. The information provided by the home said that staff are responsible to check any controlled drugs (CD) at the beginning of the shift to ensure that the totals are correct. A check of one residents CD records confirmed the number of controlled drugs held was correct and accurate. Staff were observed to be hardworking throughout the inspection, were patient, polite and caring towards the residents they helped. Residents dignity was maintained during care sessions, and residents were positively included in conservations. Staff knocked on the residents door before entering, and respected their privacy. One resident told me, All in all this is a good home. I find the staff are very pleasant. Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect flexible lifestyle opportunities that meet their expectations of the service, including opportunities to meet with family and friends, participate in social activities, and receive wholesome nutritional meals. Evidence: The information received from the service (the AQAA) informed us, The plans for entertainment are discussed at The Residents Association Meetings. The residents at Holmwood have enjoyed a wide variety of external trips this year and they have all been very well attended, for example, two trips on the Norfolk broads. Highway nurseries, and a garden party is planned at one of the relatives in early August and we plan to hold our garden fete on the 17th August, the knitting group as been busy knitting objects to sell at the fete. Monies raised will be invested back into the residents entertainment account to fund future trips away. Discussion with a group of 5 residents confirmed that Holmwood offered them a diverse and flexible lifestyle which included access to a range of local events and activties. The residents said that there were always events happening at the home, with featured events usually each week. On the day we inspected the home, a theatre Care Homes for Older People Page 17 of 33 Evidence: group provided entertainment for many of the residents during the afternoon. A Christmas party had been planned for residents, relatives and local healthcare staff for later in the week, and preparations for this event were underway. Some residents said they enjoyed games of scrabble with the other residents, and when the weather is nice, they like to spend time in the garden. Other activites undertaken in November included a quizz night, armchair exercises, arts and crafts, card decoration, reminiscence therapy, walks to town or reading the newspaper. One resident said, Individually, we each do what we are capable of doing, so this does differ from person to person. Another resident said, I am able to attend the local church service, and can go to town if I wish. Feedback from 6 of 7 residents told us that there are always activities arranged by the home, that they could take part in. One said sometimes. The residents association is open to all residents at the home, and meetings are held around 4 times a year. Residents can contribute their suggestions and ideas at the meeting and feedback is provided to the homes, for consideration. For example, the type of meals they would like. The home also sends questionnaires to the residents twice a year to receive feedback around all aspects of the quality of the care provision offered. Residents told us that families and friends are always welcomed at the home and that there were no restrictions placed on visiting times. Visitors were seen calling at the home throughout the day, and were able to spend time with their relatives or friends. One resident said, I have good contact with my family. The residents told us they they are included in the decision making process at the home, including being asked the types of activities or meals they would like. Feedback from a relative said.They make everyone feel as if it was our home!. The home also supports some residents with more specialised needs, for example people with a diagnosis of dementia. Some of these residents were observed relaxing and eating their meals with support, in the smaller lounge, where it was quiet and peaceful. Two quite frail residents were also observed being supported by a staff member during lunch, in their own-shared room. Additional staff support is provided, which ensures that these residents receive individual support and personal encouragement. Staff were observed speaking respectfully to these residents, were unhurried and engaged with them in positive conservation. The residents were seen to be well groomed, dressed in their own clothes, and up in their chairs during the day. Residents who wish to are encouraged to take responsibility for their own finances, and some are supported to handle small amounts, for any personal needs they may have. Residents can keep their money locked in the homes safe for safekeeping, and this is protected by robust recordkeeping procedures and checks. Three residents Care Homes for Older People Page 18 of 33 Evidence: money held was checked against the records and were found to be accurate. Lunch on the day of the inspection was served hot by staff between 12 to 12:30, directly from the kitchen to the residents dining tables, which are located immediately next door. The tables were set with tablecloths, condiments, napkins and cutlery, with festive decorations included for each table. The main menu for the day was roast beef, Yorkshire pudding, carrots, potatoes, and cabbage. Dessert included strawberry crumble or stewed apples and custard. The food looked and smelt appetising. Several residents we spoke with said that the meal was tasty and sufficient for their needs. During lunch the residents used the occasion to talk with friends about their day at the home. Although their was no listed second hot option choice on the menu, the cook confirmed she could provide other hot meal options on request. Residents would therefore benefit from a second hot meal menu choice, and the manager told us that this would be sorted shortly. The selection of the main hot course meals for each of the 7 days during the week included Normandie Pork, Meat loaf, Lancashire Hot pot, Roast beef, Christmas buffet, liver or sausages and Roast lamb. Feedback from 7 of 7 residents said that they always or usually like the meals provided by the home. One staff member commented, The home is famous for its food!. Some of the residents we spoke with said, We find the food here very good, or The food is very good and acceptable. There is plenty to eat, the food is fresh and we have no complaints. When asked about the single main meal option they said, Its always been like that, so we get used to it. We can ask for other options though, if we need to. During observation of the meal time period, one residents soft meal diet was noted as having been blended together. Soft diets for the residents could be improved by ensuring constituent parts are separated for their enjoyment and taste, and improved menu records would show how the home meet each residents individual meal choices and options. Care Homes for Older People Page 19 of 33 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. Residents can expect their concerns to be listened to and action taken when required, and they would be kept safe from abuse, neglect or self-harm. Evidence: The information provided by the home (the AQAA) said, Our policies and procedures for the protection of vulnerable adults, whistle blowing and complaints have all been reviewed in July 2008. The complaints procedure is displayed in reception and the procedure is also explained in our brochure which every resident receives prior to coming into Holmwood. Residents and families are also advised how to contact the Commission for Social Care Inpsection via the complaints procedure and/or the brochure. The home has a complaints procedure available for the residents and a copy was seen on display in reception, which the residents could readily access. The complaint book was checked and 2 complaints had been received during the previous year. One complaint was around a personal care matter, while the other was around a food issue. Both complaints had been upheld by the home, and a record was maintained around the outcome. Both residents had indicated their satisfaction with the way in which the home had dealt with the matter. Feedback received from 7 residents said that they always or usually know who to speak to, if they are not happy. Further, all 7 residents said they know how to make a complaint. Care Homes for Older People Page 20 of 33 Evidence: The home has detailed policies and procedures in place for the safeguarding of vulnerable adults including whistle-blowing procedures. The home has access to the Suffolk inter-agency policy on the protection of vulnerable adults, June 2004. The manager was aware of her responsibilities in reporting any allegations of abuse to Social Services and customer first, for referral to the safeguarding team. The home has not made any safeguarding referrals in the past 12 months. Recruitment procedures checked (please refer to staffing outcome group) showed us that new employees would be thoroughly checked and cleared before they work with any vulnerable adults. Staff training records checked and feedback from staff members (please refer to staffing outcome group) informed us that they had been provided with safeguarding training by the home. At the previous inspection, concerns had been raised around one residents aggression towards staff that had not been set out in a behavioural plan. This inspection evidenced that this issue had been resolved by the home with the implementation of a challenging behaviour matrix, which records behaviour and triggers, so informs staff. An example of this plan was found in one residents records, which showed us that their behaviour patterns were being appropriately monitored by the home. Care Homes for Older People Page 21 of 33 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. Residents can expect to live in a home that is decorated and presented to high standards, is comfortable and well maintained. Evidence: The information provided by the home (the AQAA) said, Holmwood itself is evidence that we do it well. The accommodation internally and externally is beautifully decorated and maintained to this high standard. Externally we have beautiful and well kept gardens. The outside of the property is accessible via ramps which makes it safe for our residents and family to leave and enter the building. The building is odour free at all times and often our visitors will reflect upon this matter. We have freshly cut flowers and fruit bowls on display at all times. Holmwood is situated within walking distance of Bungay town centre, a library and a local community centre. The house is well appointed and decorated, comfortable and has been through a process of refurbishment. The interior and exterior has been decorated to high standards, which has retained some of the period features of the original older building. This provides the residents with excellent accommodation. The gardens are attractive and well kept. To the rear of the property there is a patio with a water feature. Ramps from the house to the garden have been installed to aid access for residents using wheelchairs and other mobility aids. Care Homes for Older People Page 22 of 33 Evidence: When we entered the home there was a very noticeable friendly and relaxed atmosphere, and residents were seen moving freely about the home. Staff were polite and introduced us to some of the residents, who were happy to speak with us, about life at the home. The main lounge area was well decorated, with comfortable chairs and tables, and fresh flowers were evident in these areas. There was no television in the main lounge, so allowing people to quietly read or converse with other residents. The home offers 17 single en-suite rooms and 2 double en-suite rooms. They also provide one double and 9 single rooms that do not have en-suite facilities. There are 2 fully assisted bathrooms and 6 toilets for communal use. Other facilities include a laundry and hairdressing salon. The dining room and kitchen are large and spacious helping to make meal times a social and enjoyable experience. All hygiene facilities are equipped with handwashing facilities and a poster which instructs people how to wash their hands properly. The home told us that these facilities are checked and cleaned several times per day. Each of these facilities is equipped with safety flooring to minimise the risk to the people that use it. The residents we spoke with told us they were satisfied with the accommodation and surroundings. When we asked What is the best thing about the home?, the residents said, The pleasant surroundings and the staff. Some residents said, we find the home is always kept clean and is very hygienic. Other residents told us that the home is usually warm and kept clean, although later in the day, some residents said that their room sometimes felt a bit cold. This may have been due to some unseasonably cold weather on that day. The residents bedrooms were fitted with a call bell, door lock and lockable cabinet for personal items. Rooms were well decorated and some residents had brought their own possessions with them. The homes fixtures and fittings carpets and curtains were to very good standards, and were very well maintained. The home was clean and tidy, well lit and without any unpleasant odours. Staff had access to hand washing facilities of liquid soap and paper towels in the bathrooms and toilets where they might be required to provide assistance with personal care. Staff used appropriate protective clothing during the lunchtime period and when assisting residents with personal care. The laundry facilities were not inspected on this occasion. At the previous inspection, concerns had been raised around unguarded radiators around the home, which may have presented a risk of scalding to the residents. The owners had positively addressed this issue by the provision of full radiator guards. A tour was undertaken of the premises and a sample of hot water tap temperatures Care Homes for Older People Page 23 of 33 Evidence: completed. The hot water tap temperatures for 2 of 4 hand washbasins checked were found to be excessive. Temperature checks undertaken showed us that these were 50 and 46 degrees Celsius respectively, which could cause scalding to the occupants. Shower temperature records for one residents shower for October 2008 were recorded as varying from 38 to 46 degrees Celsius. Although the shower was not currently in use by the resident, this may present a potential risk from accidental scalding to them. The manager advised us that there was a programme underway to install hot water safety valves to all residents hand washbasins, which would be completed by March 2008. She advised us that 8 residents hand washbasins still required safety valves to be fitted. The manager advised us that risk assessments were in place for each of these residents, and we were informed that the assessed risk to these particular residents was low. We checked one of the risk assessments, and while this advised us that a notice was posted above the sink, and that the resident was fully able to take precautions of running cold water, they did not tell us how this decision was reached, or if other residents could be at risk. We also checked the information provided by the home (the AQAA), which did not say how the home normally managed hot water tap temperature risks, or if hot water tap temperature checks and records were maintained by them. The provider was asked to review the risk of scalding to the residents. Advice received from the health and safety executive advised that hot water tap temperatures in hand washbasins must be maintained at around 41 degrees Celsius for the safety of the residents. This information has been passed to the home. The provider advised us that hot water safety valves had been fitted to the remaining hand washbasins, shortly after our inspection. A further site visit undertaken at the home on the 23 January 2009 confirmed this, and checks of several hand washbasins showed us they were now delivered at safe levels for the residents. The providers also showed us they had improved monitoring, by monthly hot water temperature checks and central records. Care Homes for Older People Page 24 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be supported by sufficient staff who are qualified and trained to meet their support needs. The homes recruitment policy and practices protect the residents. Evidence: Holmwood has 25 staff in total made up of 16 care staff, which includes 5 duty care co-ordinators, 4 senior care staff, 6 care assistants, and 1 care companion. There are 2 domestics, a laundry worker, 2 cooks, 1 kitchen assistant and 1 administrator, the assistant manager and the manager. The staff roster showed us that there is a care co-ordinator plus 2 care staff on the early shift between 7-2pm (total of 3 care staff), with additional support between 710.30am. The additional support includes 1 extra carer between 7-10:30am and an additional carer between 7to 8am. The late shift has a care co-ordinator, with 2 care staff between 2 - 9pm (total of 3 care staff). There is two waking night staff on duty between 9pm- 7am, one of whom is a senior carer. Additionally there is a cook, kitchen assistant, 2 domestics and a laundry assistant working during the day. A member of staff was working 10.30-12.30, three days a week to provide additional support to residents with dementia. Care Homes for Older People Page 25 of 33 Evidence: Residents spoken with confirmed there were adequate staff to meet their needs and confirmed that staff responded to their requests for assistance. Feedback from 7 of 7 staff said that there were usually or always enough staff to meet the residents needs. One resident said,There are plenty of staff about to help us. Feedback from staff said, Situations at Holmwood vary now and then. If they are poorly, residents need more attention, but management always arrange extra staff, or Our manager increases staff ratios, when the workload increases. The manager confirmed her commitment to ensuring appropriate levels of staff. Staff training records checked showed us the home was very committed to staff training and development. Seventy five percent of staff have obtained a National Vocational Qualification (NVQ) at either level 2 or 3. The home informed us (AQAA), We have a high level of staff who are trained to at least NVQ Level 2 standard. Our care co-ordinators are all trained to NVQ Level 3. Three of our senior care assistants are currently training to NVQ Level 4. Two other senior care staff are undergoing NVQ Level 3. Two care assistants are undergoing NVQ Level 3 studies. One care assistant is undergoing NVQ Level 2 studies. The home also told us, All staff were given a revised Staff handbook in July 2007. In September 2007 all staff underwent the following training: Health and Safety, Care Planning, safeguarding training, First Aid, Mental Capacity Act awareness and Food hygiene training. Staff records checked showed that the staff members had attended a range of training to meet the particular needs of the residents, which included dementia awareness and the mental capacity act. Records checked also showed us the staff attend core training which includes moving and handling, health and safety, fire safety, infection control, first aid, food hygiene and safeguarding training. Additionally, senior staff undertake safe handling of medicines training. The manager provided an example of an induction-training pack for new staff, which was very detailed. The home said, Our two newest members of staff have undergone a supervised in-house training schedule and NVQ induction programme. They are currently completing their certificates in dementia awareness. Two staff employment files were checked and found to include the recruitment information and checks needed to ensure the protection of vulnerable adults. The records checked showed us that the agency had undertaken appropriate clearance checks before employment which included application forms, criminal records bureau (CRB) checks, protection of vulnerable adults (POVA 1st) checks, reference checking, a Care Homes for Older People Page 26 of 33 Evidence: photo, proof of identity, and a declaration of health for agency staff. Application forms included a record of the employees previous work history, and any relevant care experience to evidence their suitability for the job. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to benefit from a well-run service and can be confident that their views are sought about the running of the home. Evidence: Mrs OGrady, the manager, has the necessary qualifications and relevant experience for caring for older people. She is a registered nurse and registered midwife with a masters degree in health and sciences and a bachelor (honours) degree. She has also completed the National Vocational Qualification (NVQ) level 4, registered managers award (RMA). Mrs O Grady told us that she continues to broaden her knowledge through additional training, to which she is very committed. Feedback received from the residents and relatives confirmed that the management team were very approachable, would listen to and try to resolve any concerns they had. There was an appropriate management structure in place, which included a deputy manager, co-ordinators, and senior staff to ensure the continuous direction and Care Homes for Older People Page 28 of 33 Evidence: management of the home. The home showed us it had effective management systems and procedures in place to ensure the effective management of the home. These included appropriate complaints and safeguarding procedures, appropriate recruitment procedures, effective staff training and supervision, responsiveness to the residents via residents meetings, and an appropriate quality assurance programme to receive feedback from the residents. The information provided by the home (AQAA) said, Holmwood is committed to a high level of quality and this is reflected in our Quality Policy and reflected by well trained and competent staff. The manager is committed to providing frequent staff meetings and minutes can be accessed at all times, these reflect staff participation and are an effective forum for staff to discuss and improve practice with the aim of improving the service that we offer. The home has developed a quality assurrance plan with the key aims of fostering an atmosphere of care and support and lifestyle opportunities for the residents. The home is committed to the continous review of its service. This was seen by the production of annual quality surveys in which the home consulted with the residents and relatives. We were shown the most recent surveys, undertaken in April and September 2008. Comments received by the home from the relatives was very positive and included some of the following views. welcoming, friendly atmosphere, clean fresh interior, attractive sheltered areas outside and very good catering. many thanks to management and staff. There is a formal system of supervision in place which ensures that staff are supervised and supported on a regular basis. One staff members records checked showed us that they had received regular supervision throughtout 2008, and one new staff members records showed that the management had commenced the supervision process, by providing a supervision agreement. The home has policy for the management of residents money valuables and financial affairs. The information provided by the home (AQAA), told us, We do not manage any of the residents financial affairs. All residents manage their own financial affairs or have a relative, guardian of power of attorney to assist them with this process. Residents are provided with information when moving into the home about external advocacy services that can offer support. Our findings re the residents personal finances are discussed under standard 14. The AQAA told us that the home has detailed policies and procedures to protect the health, welfare and safety of the residents and keeps records of maintenance within the home. They said, our fire log book clearly illustrates that we conduct the Care Homes for Older People Page 29 of 33 Evidence: necessary inhouse tests and drills and that our fire prevention systems are regulary serviced by a reputable company. On a monthly basis the managers also carryout a risk assessment of the building and fire provision etc. This can be seen in our risk assessment folder with a monthly report illustrating what risks we may be currently managing and a general assessment of the whole environment from a safety point of view. The fire log was not checked on this occasion. Concerns raised with the provider around excessive hot water tap temperatures were found to be fully addressed at our second site visit. (Please see environment outcome area) Care Homes for Older People Page 30 of 33 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 31 of 33 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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