Inspection on 12/08/08 for Holly Bush Nursing Home

This is the latest available inspection report for this service, carried out on 12th August 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holly Bush Nursing Home 20/06/06

Holly Bush Nursing Home 08/11/05

Holly Bush Nursing Home 11/05/05

Holly Bush Nursing Home 13/01/05

Holly Bush Nursing Home 18/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Holly Bush Nursing Home 99/101 Gordon Avenue Stanmore Middx HA7 3QY Lead Inspector Judith Brindle Key Unannounced Inspection 12th August 2008 08:35 X10029.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 Holly Bush Nursing Home DS0000022927.V367063.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 and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Bush Nursing Home Address 99/101 Gordon Avenue Stanmore Middx HA7 3QY 020 8420 7256 020 8954 1446 mary.durkan@hollycaregroup.com 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) Holly Bush (UK) Limited Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 12 14th August 2007 Date of last inspection Brief Description of the Service: Holly Bush Nursing Home is a registered care home providing nursing care, and accommodation for up to 12 service users with learning disabilities. The registered provider is Holly Bush (UK) Limited. The care home is located in a residential area, close to the local amenities and facilities of Stanmore and Harrow Weald. These amenities include shops restaurants, banks and parks. Public transport facilities close to the home consist of bus and train services. There are ten single rooms and one shared room. No bedrooms have ensuite facilities. The bedrooms are situated on the ground floor and first floor. Bathroom facilities are located on both floors. The home has a passenger lift. There is conservatory leading to an enclosed accessible maintained garden. The care home has documentation containing information about the service it provides. Information about the range of fees, including additional charges can be obtained from the provider. This information is recorded in the statement of terms and conditions/contract documentation of the people using the service. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The unannounced key inspection took place throughout a day in August 2008. There were four vacancies at the time of the inspection. We were pleased to meet, almost all the people living in the home (one person was in hospital at the time of the inspection). The manager was present during most of the inspection. Prior to this unannounced key inspection the Commission for Social Care Inspection (CSCI) provided the care home with an Annual Quality Assurance Assessment (AQAA) document to complete. The AQAA is a self- assessment of the service provided by the care home, and is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. Due to the Commission for Social Care Inspection not having been informed of the change in the care home’s email address, the manager did not receive this AQAA. The manager accessed a template of the document from the Commission website, and completed it promptly prior to the inspection. This document could have been completed more fully, including more detail. This was discussed with the manager. A number of surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we had two completed surveys from residents, four from staff, and one from a health professional. A relative of a person using the service was also spoken with. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the service, these are called notifications, and are a legal requirement. Also assessed was relevant information from other organisations, and from what other people might have told us about the care home. All but one of the people using the service were spoken with. Most of the residents have significant communication needs, some of who respond to questions with gestures and/or sounds or few words. Due to the varied communication needs of the residents, observation was a useful, and significant tool used during this inspection. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 6 Documentation inspected included, three of the care plans of people using the service, risk assessments, staff training, three staff personnel records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements from the previous inspection had been met also took place during this inspection. These were judged to have been met by the care home. 25 National Minimum Standards for Adults, and Older People including Key Minimum Standards, were inspected during this inspection. The inspector thanks the people living in the care home, the manager, the staff, and all those that provided feedback about the service provided to residents. What the service does well: What has improved since the last inspection? Requirements from the previous key inspection (14th August 2007) have been met by the service. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 7 A significant number of improvements have been made to the environment. These include decorating most communal areas, some bedrooms, and replacing the flooring in the kitchen and some bathrooms. A conservatory has also been built. The format of the care plans has been improved. Information about resident’s needs is more accessible to staff and is more detailed, so that staff have a good understanding of how to meet the needs of people using the service. Residents have more opportunity to participate in community based activities, including being supported by staff to purchase personal items from local shops. The medication storage and administrations systems have been improved. A new medication cabinet has been provided and medication is administered from monitored dosage packs, staff have also received ‘refresher’ medication training. This contributes in ensuring that medication is administered safely to residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above, and Standard 1 (Older People and Adults) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information needed to choose a home that will meet their needs. The format of this information could be developed to improve the accessibility of the information to people using the service. Prospective residents have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need EVIDENCE: Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 11 The manager told us that she was in the process of reviewing the statement of purpose and the service user guide documentation. These documents provide prospective residents, and others with information about the service that the care home provides to people. The statement of purpose was not available for inspection, but a recently reviewed copy of this document, was supplied to the Commission for Social Care Inspection promptly, following the inspection. This document was judged to include the required information needed for people to make an informed choice of where to live. It includes information about the service incorporated in the fees, as well as information about any costs not included, such as drycleaning and purchasing toiletries. The pre reviewed service user guide was accessible. It was evident that residents had been given a copy of this document. The format of the service user guide could be developed (i.e. possibly in audio and/or picture format) with people using the service, to improve its accessibility to residents. The home has an admission procedure. The manager told us of the admission process. This involves a referral from the funding local authority. Then a comprehensive initial assessment of the person’s needs, from a competent person from the organisation (usually the manager), with participation from the community nurse, prospective resident, and sometimes their relatives/significant others. Care plans inspected included evidence of assessment resident’s care needs. This includes an initial assessment. There was also some evidence of assessment of resident’s needs having been carried out by the Local Authority. We were told that when a person decides to move into the home, there would generally be planned process of transition. This would include visits to the home so that a prospective resident would be able to meet residents, and have the opportunity to assess the facilities to determine that the home can meet their needs. We were told that the most recently admitted resident, moved into the care home for respite care and support without visiting first, due to particular personal circumstances, but that this person’s family members did visit the care home before their relative moved in for their respite stay. We were told that there is a trial period of living in the home before a placement is confirmed. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service each have a plan of care. There could be some development in the care plans to ensure that it is evident that the resident participates in their plan of care, and that it’s information is more accessible to residents. People using the service are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 13 EVIDENCE: All the people using the service have an individual plan of care. The three care plans inspected showed evidence that they had been reviewed regularly. They included information about resident’s personal goals, and preferences, and covered aspects of the person’s health, personal care, and social needs. Guidance to meet residents agreed goals was documented. It was evident that the care plans are up dated as resident’s needs change. Feedback from staff confirmed this: ‘care plans are updated weekly/monthly as the needs arise’. Daily progress records documented that a resident had ‘panic attacks’, a health assessment of another resident recorded that this person was ‘non compliant’ at times when receiving a medication. These issues were not included in the person’s plan of care. Care plans need to be further developed to ensure that resident’s behaviour needs are assessed and guidance recorded to ensure that staff know how to manage various episodes of unsociable/challenging behaviour. The care plans could indicate more understanding, and assessment of the strands of diversity, including race, gender identity, disability, sexual orientation, age, religion and belief. This was discussed with the manager. AQAA documentation told us that there are equality and diversity policies in place, and that this is covered in the staff induction programme. It is recommended that staff have the opportunity to receive further equality and diversity training. The manager spoke of plans to develop the use of sign language, and Makaton to improve communication with people using the service. We were told by staff that that each person using the service has a key worker, and a ‘named’ nurse. Staff informed us that the key working role (and named nurse role), includes shopping with residents for their personal toiletries, and clothes, and also participating in the review of the person’s care plan, as well as arranging and accompanying residents to health appointments. Staff told us that ‘service users are well cared for, and all their needs are well attended’, and said that the care home gives residents ‘a choice in their daily lives, and provides the highest quality of care’, and that residents ‘rights are respected’. Daily and night residents progress records are documented. During the inspection there were several examples of staff providing residents with choices, and supporting people with making decisions about their lives. Choices included asking whether residents want a drink and what activities they preferred to participate in. Staff were observed to respect resident’s decisions, and preferences. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 14 It was observed during the inspection that a resident was given her own post to open. Residents have access to a telephone. It was evident that individual resident’s risk assessments are carried out, and that these are reviewed regularly. These include nutritional, falls and pressure sore, and bedrail risk assessments. The care plans could include more evidence of development in risk assessment such as addressing safety issues, (including road safety, risk of stairs, behaviour, bathing risk assessments) while aiming to improve outcomes for people. Care plans indicated that the personal care needs of people using the service are assessed, and met by the home. A resident told us that she had had her hair washed that morning, and spoke of choosing her clothes. The resident was heard to ask staff to assist her with putting on a garment. Staff responded positively to this. Records and staff have their health care needs assessed and met. A health assessment was included in a person’s care plan file. We were told that a doctor visits the home every two weeks to review their medical needs. Appointments to the dentist, GP, psychiatrist, chiropodist, and optician are documented. The manager told us that there is liaison with the tissue viability nurse, as and when needed by residents. Records and staff confirmed that people using the service are supported in attending hospital appointments, including specialist medical clinics. Feedback from a survey completed by a health professional told us that individuals’ health care needs are met by the service, and that individual’s privacy and dignity are respected by the care service. It was noted during the inspection that a resident had an inflamed ‘sore’ area near their thumb. The manager following assessment told us that she would arrange a GP appointment for this person. Following the inspection a nurse told us that a GP appointment had been arranged for this resident. The manager informed us that a resident’s chronic medical condition had improved significantly due to the quality of care provided by the staff. She spoke of how this person’s mobility had improved considerably following receipt of quality care and support from staff. The manager told us that medical staff at the hospital clinic where the resident regularly attends were pleased with this person’s progress. We were told that three residents had recently each received a new wheelchair. The home has a medication policy. We were told that the care home had recently changed their pharmacist. Most of the medication is now being administered by a monitored dosage system in which the pharmacist supplies the medication to the home in individual dosages in a blister pack. The manager told us that this had significantly improved the system for Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 15 administering medication, and had improved the safety of medication being administered to residents. The medication is stored securely. The manager told us that a new medication cabinet had recently been purchased. The manager told us that the care home was expecting a visit from the pharmacist on the day of the inspection when they would check the medication storage and administration systems. We were told that the registered nurse on duty administers medication. Records confirmed that nurses had recently received refresher training in medication management. We checked the medication administration record sheets. These were well completed by staff and we saw no errors or omissions in these records. The manager told us that she monitors the medication records to ensure that staff have always signed this documentation, appropriately. The medication received by the home is documented. The manager and records told us that resident’s have their medication regularly reviewed by a doctor. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. There could be further development in providing residents with more opportunities to participate in varied preferred activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 17 Meals provided are varied, and wholesome and meet the varied needs of people who use the service. EVIDENCE: Staff told us that residents participate in activities. These include ‘in house’ and community based leisure pursuits. Resident’s preferred activities were recorded in their initial assessment documentation. The care plans could be developed to include social/activity needs, and guidance to meet these needs, with timescales to achieve these goals/objectives. Staff told us that activities resident’s enjoyed were puzzles, knitting television, board games, drawing, word games, and art and craft sessions. AQAA information told us that the variety and number of activities have been developed, since the last key inspection. The manager told us that a resident now has a regular therapeutic massage. She said that since the person had commenced these sessions his/her behaviour had significantly improved and that he/she is now much more calm. The manager told us that she was ‘working’ on reviewing the individual activity programmes of each resident. An individual activity programme should be available for each resident, in a format that is as accessible as possible to the person. Two people using the service attended a day resource centre on the day of the inspection. We were told that a resident who used to attend the day centre was not presently going to the centre due to issues to do with funding the day care sessions. This issue should be sorted out as soon as possible particularly as we were told that she/he was missing seeing her/his friends at the centre. The manager told us that she closely liaises with the resource centres, and has spent time at a day centre gaining knowledge and understanding of the activities, leisure pursuits that residents enjoyed. This is positive. We were told that the home plans to include reminiscence therapy as part of the care home’s activity programme. The manager told us that since the last key inspection, she had developed the opportunities for residents to participate in many more local community activities. Residents now regular go out with staff to the local shops, and buy items including their personal toiletries. We were told of the great pleasure that residents get from participating in these activities. The manager told us that a resident was being supported to learn about handling money. Staff informed us that there were plans to support residents to access more community facilities including the hairdressers. Records that demonstrate the number and varied activities that residents participate in were not accessible. Resident’s ‘daily’ progress records tended to record the personal care and health care needs of people using the service, Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 18 with little evidence of details of the activities that residents participated in during the day. This was discussed with the manager. The home employs a full time driver, who drives the care home’s passenger vehicle, and takes residents on regular day trips, to places such as Oxford, and local garden centres. As well taking residents to health appointments. The visitor’s record book informed us that the home has regular visitors. Care plans we saw included a record of the person’s life story, and contact details of each person’s relatives/next of kin. Visitors included relatives of people using the service, and other stakeholders such including Care Managers. A resident told us that she/he had recently had a visit from relatives, and that they had taken her/him out for a birthday celebratory lunch. A relative of a resident told us that she/he visited the care home regularly to see a family member. She/he spoke positively of the care home, and of the support and care provided to the resident that she/he visited. We were told that relatives/significant others can join residents for meals in the home. Staff told us of the positive contact that residents had with their families. The home employs a cook, for 35 hours a week. The menu was available for inspection. This was a four-week menu displayed in the dining area. It was in written format, though there were some photographs of meals on this board. The format of the menu was discussed with the manager. She spoke of her plans to look into ways of improving the accessibility (with input from residents and relatives/significant others) of the menu information to residents. This is positive. The manager told us that she had improved the way the dining tables are laid at meal times, and ensures that saucers are provided with cups for drinks, and that napkins are available to residents. A variety of fresh, frozen, dried and tinned foods were stored. Fresh fruit was accessible in the kitchen. A resident told us that she had enjoyed her breakfast. Lunch during the inspection was freshly cooked and was judged to be nutritious and wholesome. A resident was given a meal that met his/her particular cultural needs and preferences. Food eaten by people using the service is recorded. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The care home has a complaints policy, which includes timescales, and recording procedures. A summary of the complaints procedure is recorded in the service user guide. A resident’s feedback survey told us that they did not know how to make a complaint. The manager needs to ensure that all resident’s, (and other stakeholders) have knowledge and understanding of the complaints procedure. The complaints procedure could be discussed during resident’s meetings. The format of the written complaints procedure could be improved, and developed to possibly include pictures or be in audio format, to make it more accessible to residents who may have difficulty in reading. AQAA information Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 20 told us that she planned to produce the complaints procedure in Makaton (a format of sign language). A staff member spoke of the ways that she and the staff team respond to ‘concerns’/complaints from people using the service, and others. The manager confirmed that she was continuing to improve the systems and practices of recording any ‘concerns’ raised by residents, relatives and others. The home has a complaints record book. AQAA information told us that there had been no complaints within the last twelve months. The care home has a safeguarding adult’s policy/procedure, and a copy of the lead Local Authority safeguarding adult’s guidance. Records and staff told us that staff have received safeguarding adults training, so that they knew what action that they need to take if there is an allegation or suspicion of abuse. We spoke with some staff on duty during the visit and they demonstrated a good understanding of the home’s safeguarding procedures. Recorded feedback from staff also indicated that staff had an understanding of the complaints procedure. Records informed us that recruitment and selection procedures include ensuring that staff receive an enhanced Criminal Record Bureau check (to gain information as to whether the person has a criminal record) prior to their employment. There are procedures in place for ensuring that accidents/incidents are recorded and reported appropriately. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above, plus Standard 23(Older People). People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, and comfortable. The premises are suitable for the care home’s stated purpose; there are areas of the environment that could be improved. Resident’s bedrooms, meet their individual needs, and are individually personalised. EVIDENCE: Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 22 The care home is located close to Stanmore and Harrow Wealdstone. These areas have a variety of amenities, including shops, restaurants, parks and banks. There are public bus and train facilities near to the care home. The inspection included a tour of the care home. The entrance to the care home is attractive. There are hanging baskets with flowers and pots of plants near the entrance to the home. There is a ramp leading up to the front door. Off street parking is available for several cars on the forecourt of the care home. The home was clean and odour free. We were told that there are areas of the care home that had been redecorated since the previous key inspection. These include some communal areas, and bedrooms. We were told that the flooring has been replaced in the kitchen and some bathrooms. The home employs a maintenance person, who told us that he was in the process of decorating other areas in the home and attending to maintenance issues. AQAA information told us that there were plans to redecorate all areas in the home. The manager told us that the care home was in the process of having all the bedrooms redecorated, and that residents are also being provided with new bedroom furniture, which we were told had been ordered. Beds have been replaced so that they meet resident’s mobility needs. This is positive. A resident confirmed that she had chosen the colour of the paint in her bedroom, and spoke of being happy with her bedroom. Bedrooms were individually personalised, with lots of photographs, and ornaments. Rooms inspected each had a television in them. A conservatory has been added to the premises since the last key inspection. This is an attractive feature with seating for residents and others. A relative of a person using the service told us that she often sat in this conservatory with her family member when visiting him/her. The home has an infection control policy/procedure. Laundry facilities are located away from food storage, and food preparation areas. The manager told us that new machines had been purchased. Hand washing facilities are located throughout the home. The manager has had new soap dispensers and hand towel dispensers fitted throughout the care home. This is positive. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records confirmed that staff had received infection control training. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices promote the safety and welfare of the clients. Staff receive training that supports the aims and objectives of the service and legislative requirements. EVIDENCE: The staff rota was available for inspection. There are generally 2 care staff , a registered nurse and the manager on duty in the home during the day and at night there is a ‘wake’ night registered nurse, and a care worker on duty. Other staff employed in the home includes domestic staff, a cook, handyman and driver. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 24 Staff were observed to be very approachable and interacted with residents in a sensitive manner during the inspection. The home has a staff induction policy/procedure. Staff told us that they had received an induction when they commenced employment in the care home. A completed staff induction record was available for inspection. Staff, records and staff surveys confirmed that new staff receive an induction programme, when they commence employment, which ensures that they have a good understanding of their role and of the systems in place for providing a quality service to residents. The manager told us that the staff induction is linked to Skills for Care. AQAA information recorded that 49 of home staff have achieved an NVQ (National Vocational Qualification) level 2 care qualification. The manager told us that there were four staff that had nearly completed the NVQ level 2 care course, and that there were plans to ensure more staff achieve this qualification. We were told that staff would have the opportunity to achieve a NVQ level 3 care qualification. The home should ensure that all care staff have the opportunity to achieve an NVQ level 2 care qualification. At least 50 of staff should have this qualification. Staff training included, medication training for registered nurses, fire awareness, First aid, manual handling, health and safety, food and hygiene training, dementia care training. Certificates of staff training were accessible in the staff personnel files. Each staff member should have an individual staff training analysis plan. AQAA information told us that there are plans to improve the staff training records. Recorded, and verbal feedback from staff told us that they are given training that is relevant to their role. The manager spoke of plans for staff to receive Mental Capacity Act (2005) training. A health care professional told us that care staff have the right skills and experience to support individual’s social and health care needs, and other needs. The care home has a recruitment and selection procedure. Three staff personnel files were inspected. These contained required information including confirmation that staff have received an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key standards as above. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 26 The management and administration of the home is based on openness, and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. EVIDENCE: The manager has managed the care home since December 2007. Prior to that date she had managed another of the Organisation’s care homes. She is an experienced care home manager, and is a registered general nurse, and learning disability nurse. The manager told us that she achieved the Registered Manager’s Award qualification in 2006. She told us that she has supported and cared for people with a learning disability for more than 18 years. The manager confirmed that she regularly undertakes periodic training to update her skills and knowledge. It was evident that the manager, since taking up the post of manager has instigated significant improvements to the service. These included improving the environment, reviewing and improving care plans, and medication administration systems. The manager told us that she was aware that there are still improvements that could be made to the service and spoke of the plans for carrying these out. The care home should have a computer to particularly enable the manager to improve and develop some areas of record keeping such as resident’s finances. The manager and records confirmed that she had commenced the process of registering with the Commission for Social Care Inspection. Records and the registered manager informed us that the care home monitors the quality of its service provided to residents. We were told that the manager carries out a monthly audit of systems including staff training, pressure area care, medication administration, and health and safety arrangements. The AQAA confirmed that required, appropriate, reviewed policies and procedures were in place to ensure that the residents are provided with a safe, quality service, and that satisfaction surveys are supplied to all relatives, whose views are acted upon. Care plans and other records were up to date. Records confirmed that a representative from the organisation carries out a monthly audit of the systems of the care home. Records confirmed that resident, and staff meetings regularly take place in the home. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 27 Records of one to one staff supervision sessions were seen. A staff member confirmed that she received regular supervision, to support her in understanding and carrying out her roles and responsibilities. The care home has a policy/procedure with regard to the management of the finances of people using the service. We were told that relatives, the Court of Protection, or Local authority manage resident’s finances. All the residents have support with their finances. Records of financial allowances, and expenditure are maintained. We were told that regular checks of balances and expenditure are carried out. The manager told us that she is in the process of improving the systems for recording resident’s purchases and expenditure. This is positive. The home has health and safety policies and procedures. Fire safety guidance is displayed in the home. Required fire safety checks and fire drills are carried out, and there is a fire risk assessment. Records informed us that one fire drill was carried out this year. Staff informed us that another fire drill was due to take place before the end of the year. The care home should look into carrying out more fire drills to ensure that it is evident that the home arranges sufficient fire drills to ensure that all staff (including night staff) attend a fire drill twice a year. Fire drills should take place at varying times of the day. Records informed us that the care home has procedures in place to ensure that staff know how to respond in an emergency. Documentation told us that the equipment (including the bath hoist) located in the home has been serviced or tested as recommended by the manufacturer or other regulatory body. Certificates of up to date required gas and electrical system service checks, and equipment checks were available for inspection. The home has a passenger lift that is serviced as required. Radiators in the care home are covered. The home lets us know about things that have happened; they have shown us that they have managed issues appropriately. The home has an accident policy/procedure. Incidents and accidents are recorded as required. The registered person should ensure that she reviews the food and hygiene staff training as recommended following a recent Environmental Health Inspection. We were informed that she planned to enrol staff on a food and hygiene training course that is carried out by the Local Authority. The home has an up to date displayed employer’s liability insurance certificate displayed in the care home. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 28 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 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 3 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 3 37 3 38 3 Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? 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. 1 Standard OP7 Regulation 12 Requirement Care plans need to be further developed to ensure that resident’s behaviour needs are always assessed and guidance recorded. To ensure that it is evident that staff know how to manage all episodes of behaviour from residents that might challenge the service. The manager needs to ensure that all resident’s, (and other stakeholders) have knowledge and understanding of the complaints procedure. The manager needs to be registered with the Commission for Social Care Inspection. Timescale for action 01/10/08 2 OP16 22 01/10/08 3 OP31 8 CSA Part 11 (11)(1) 01/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The format of the service user guide could be developed DS0000022927.V367063.R01.S.doc Version 5.2 Page 30 Holly Bush Nursing Home (i.e. possibly in audio and/or picture format) with people using the service, to improve its accessibility to residents. The statement of purpose should be accessible in the care home. There could be some development in the care plans to ensure that it is evident that the resident participates in their plan of care, and that the care plan information is more accessible to residents. The care plans could indicate more understanding, and assessment of the strands of diversity, including race, gender identity, disability, sexual orientation, age, religion and belief. The care plans could include more evidence of development in risk assessment such as addressing safety issues, (including road safety, risk of stairs, behaviour, bathing risk assessments) while aiming to improve outcomes for people. The care plans could be developed to include social/activity needs, and guidance to meet these needs, with timescales to achieve these goals/objectives. An individual activity programme should be available for each resident, in a format that is as accessible as possible to the person. The issue of a resident attending or not attending a day resource centre that she/he was previously attending should be resolved as soon as possible. 4 OP15 Activities participated in by residents should be recorded. The home could look into ways of improving the accessibility (with input from residents and relatives/significant others) of the menu information to residents. The format of the written complaints procedure could be improved, and developed to possibly include pictures or be in audio format, to make it more accessible to residents who may have difficulty in reading. There could be development in the systems and practices of recording any ‘concerns’ raised by residents, relatives and others. Each staff member should have an individual staff training analysis plan. DS0000022927.V367063.R01.S.doc Version 5.2 Page 31 2 OP7 3 OP12 5 OP16 6 OP27 Holly Bush Nursing Home 7 8 OP28 OP37 The home should ensure that all care staff have the opportunity to achieve an NVQ level 2 care qualification. At least 50 of staff should have this qualification. The care home should have a computer to particularly enable the manager to improve and develop some areas of record keeping. The Annual Quality Assurance Assessment could be completed more comprehensively to ensure that the Commission has detailed information about the care home and of the plans to develop and improve the service for residents. The care home should look into carrying out more fire drills to ensure that it is evident that the home arranges sufficient fire drills to ensure that all staff (including night staff) attend a fire drill twice a year. Fire drills should take place at varying times of the day. The registered person should ensure that she reviews the food and hygiene staff training as recommended following a recent Environmental Health Inspection. 9 OP38 10 OP38 Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Holly Bush Nursing Home DS0000022927.V367063.R01.S.doc Version 5.2 Page 33 - 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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