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Inspection on 22/01/09 for Holmwood House

Also see our care home review for Holmwood House for more information

This is the latest available inspection report for this service, carried out on 22nd January 2009.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Detailed policies and procedures are in place, and these ensure that the needs of people living in the home are identified, and can be met. The service is good at meeting the needs identified, and the relationship between the management, staff and residents very good, and communication with families very comprehensive. During our visit, one person told us it was better than living at home, another that everything you could wish for was available, and a member of staff told us that it was the best home she had ever worked in.

What has improved since the last inspection?

Since our last visit, many parts of the home have been refurbished, including the front hall, a number of bedrooms, the laundry and staff facilities and the office, and new equipment provided including specialist beds and mattresses, to meet residents needs. Revised care plans were introduced in September last year, and staff training has increased, and at the present time almost all the staff working in the home have achieved or are working toward NVQ qualifications. New menus have been introduced, and these offer residents a wider choice of meals, and the introduction of a daily fruit trolley with a variety of fresh fruit has proved very popular.

What the care home could do better:

There were no major concerns resulting from our inspection visit, and we discussed planned improvements that the home intend to make with the management. These include ongoing refurbishment of the home, including the main lounge and bedrooms as required. Qualified staff will be taking a lead on providing specialised training to other staff in areas such as diabetes, Infection control, wound care and catheter care

Key inspection report Care homes for older people Name: Address: Holmwood House 40 Whitecross Road Swaffham Norfolk PE37 7QY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alan Buttery     Date: 2 2 0 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Holmwood House 40 Whitecross Road Swaffham Norfolk PE37 7QY 01760724404 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: achilvers@inhcare.com IntegratedNursingHomesLimited Integrated Nursing Homes Ltd care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Room numbered 101, which is on the first floor, can only be occupied by a person who is independently mobile. Date of last inspection Brief description of the care home Holmwood House is a care home with nursing, and following the recent completion of a new extension now offers care and accommodation for up to 62 residents. The home is located within easy walking distance of the town centre of Swaffham and is close to all local amenities, shops and pubs. Holmwood House is a large Georgian house, with recent extensions. It stands in its own grounds and has a car park at the front of the home. 17 0 4 Over 65 0 62 0 Care Homes for Older People Page 4 of 23 Brief description of the care home The new manager of the home confirmed that the current fee range is #315:00 to #625:00, dependent upon the care received. The fees are made available to potential residents and/or their representatives before moving into the home and are included in the Service User Guide. Residents are advised of any increases to fees in writing. A copy of the last inspection report is available in the reception area of the home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, and during our visit, we were provided with information and documentation by the providers regional manager and by the newly appointed manager of the home. On the day of our inspection we looked at a number of records on the home, including resident and staff files, health and safety records and ancillary information, and were taken around the home. We also spoke to some of the residents and staff, and views expressed by them are reflected in the report. Care Homes for Older People Page 6 of 23 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 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. Full assessments are carried out prior to anyone moving into the home to ensure that their identified needs can be met, in a way suited to the individual Evidence: The process of any admissions to this home was discussed with the regional manager, and the newly appointed manager of the home. This would normally involve a visit from either the person thinking of moving to the home, or more often a member of their family. As we arrived at the home to carry out the inspection, the daughter of a prospective resident was visiting, and was given information about the facilities, and looked around the home, and at a room currently available. Initial enquiries come either directly from the family member, or from the local health or social care teams. The service has an initial enquiry record in which brief details of the enquiry are recorded, and this where the enquiry develops into a prospective admission, a pre admission assessment is carried out, normally by the manager of the Care Homes for Older People Page 9 of 23 Evidence: home, to ensure that the identified needs of the person can be met. During our visit, the four care files we looked at all included the detailed assessment information, and clearly showed the identified needs of the person concerned, and how these needs would be met. Holmwood is able to provide both nursing and social care, and is also registered to provide support to people with dementia, and can therefore try to provide a home for life, unless the needs of a person living in the home changed to the extent that the home was no longer able to meet them. The service does not offer intermediate care. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual plans guide staff in meeting identified health and social care needs in a way suited to the individual. Evidence: Once the initial assessment process has been completed, and it has been agreed that the identified needs of the person can be met by the service, arrangements for the person to move to the home are made, and initial care plans written, and again evidence of these was seen on the files examined. The initial plans cover the first 72 hours or so of the admission, and during this time, more detailed individual plans are written, and the new resident closely monitored. The four care plans that we examined included details of the persons background and history. The plans include details of the support needs for both health and social care. They included a life review which goes into more specific detail on the persons, their background and social history. The care plans that we examined showed evidence of recent review, with one in Care Homes for Older People Page 11 of 23 Evidence: particular showing an excellent programme of review, demonstrating very clearly that the person carrying out the review had ensured that it was thorough, and although no changes were made, it was clear that this had been carefully considered. However, other files examined showed that although the individual pans have been reviewed recently, at times over the past year, the reviews have not taken place on a regular basis, and the service needs to ensure that reviews are carried out at least once a month, or sooner if needs are changing. An error in recording weight for one resident was also acknowledged by the service, and steps are already being taken to ensure that these are taken and recorded accurately. The service should ensure that the plans are signed and dated by the person completing them, and clearly show the involvement of the person they relate to, or their families. The service has a good working relationship with the local health professionals, and use three local GP surgeries, and district nurses from the surgeries assist the residential residents in the home with nursing needs. Other health professionals including Occupational therapists, physiotherapists, speech and language professionals and dieticians are involved on an ongoing basis with a number of the residents living in the home. Medication throughout the home is administered by the qualified nurses, and the service uses the Boots monitored dosage system. At the present time no one in the home is able to manage their own medication, although procedures are in place to ensure that anyone wishing to do so, would be supported accordingly. Care Homes for Older People Page 12 of 23 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. People living in the home are able to take part in a range of activities and events, with choices available, and are offered a range of appetising home cooked meals. Evidence: As mentioned earlier in the report, wherever possible, a detailed social history is gathered, to ensure that the person living has access to a range of activities and events they enjoy. The service employs a dedicated member of staff who coordinates events and activities, aimed specifically at individually identified needs as well as generalised activities, suited to everyone living in the home. These include scrabble, music, arts and crafts, board and ball games, regular entertainment, singing, skittles and individual one to one time. Other organised activities include clothes parties, themed events such as Race nights, an annual fete, and Christmas parties. The service has good links with their local community, and the local mayor visits at Christmas, and usually opens their summer fete. Care Homes for Older People Page 13 of 23 Evidence: Although the service does not have its own transport, the regional manager advised us that the local taxi service is very good, with wheelchair transport available. Visitors are welcome at all times, and can spend time with in the lounge or residents own room, or in the conservatory, and are included in many of the events held in the home. A new chef has recently joined the service, and introduced a new menu, which is very popular with the residents of the home. A copy of the menu was given to us during our visit, and includes a choice from 3 main courses a day, which include a good range of home cooked, locally sourced food. A variety of teas and suppers are served, and again a choice is available. He has also introduced a fruit round with a variety of fresh fruit available, and this is proving very popular. Residents we spoke to during our visit said that the food was much better now, and we were also able to speak with the chef, who plans to develop his menus, and the variety of food further, and incorporate themed nights with foods from around the world. A monthly newsletter keeps people up to date with plans and changes, and the January edition was seen during our visit. It keeps residents up to date with birthdays, staff changes, has some humour, details of coming events and meetings. Care Homes for Older People Page 14 of 23 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. Procedures are in place to ensure that any concerns complaints or allegations are dealt with, and people living in the home are aware of how to make their concerns known. Evidence: Everyone moving into the home has a copy of the homes complaints procedure, and is aware of who to speak with if they have concerns, and people that we spoke with during our visit confirmed this, although the policy needs to be updated to ensure the information is up to date. Records showed that six complaints had been received in the past eighteen months, and all had been quickly resolved. We also saw a number of compliments that the home have received. The residents we spoke to during our visit were aware of how to make a complaint and happy that their concerns would be listened to. A policy is in place to ensure the safeguarding of the people living in the home. All staff receive training in safeguarding matters, and regular updates, and supervision includes discussion on safeguarding issues with individual staff members. The service also ensures that family members are aware of procedures followed in the Care Homes for Older People Page 15 of 23 Evidence: event of any allegations of abuse being made. Care Homes for Older People Page 16 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is set in pleasant grounds and offers a clean and safe home to the people living there. Evidence: The home provides a comfortable and homely environment for the people living there. Communal space is good, with two large lounges and a dining area with attached conservatory. Individual rooms are well equipped and during a tour round the home, it was clear that people are encouraged to bring in personal items and possessions. Suitable toilet and bathing facilities are available. The home is set in pleasant grounds, within easy reach of local facilities. Care Homes for Older People Page 17 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are in place to ensure that suitable staff are in place to meet the needs of the people living in the home. Evidence: On the day of our visit, there were clearly sufficient staff to meet the needs of the people living in the home, There are normally at least three care staff available at busy times, with two at all times and in addition, domestic and catering staff are working. The service has a detailed recruitment policy in place, and five staff records were examined which all contained information in accordance with the regulations, and details of the training provided. Since the new owners took the service over, a better range of training has been provided to All staff including all mandatory training as well as some specific training in dementia, diet and infection control. Care Homes for Older People Page 18 of 23 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. Health and safety procedures ensure the safety of people living and working in the home, and residents are able to contribute to decisions that affect their day to lives through residents meetings. Evidence: The home have recently appointed a new manager, who was previously deputy manager of the home. She is experienced and well qualified, and will be submitting an application for registration with the commission in due course. At present, she is being supported by the companys regional manager, who has been based at the home during the period of change. People living in the home commented favourably on the surroundings and the support they receive, one person saying how happy she was, another commenting very favourably on the choice and variety of food served. Care Homes for Older People Page 19 of 23 Evidence: Another resident that we spoke with said that the home provided a much better service than it used to. A quality assurance process is in place to ensure that the views of people living in the home are obtained, and those of families, and these views are taken into account when planning future changes support provided. A detailed report has been produced and a copy of this provided to the inspector. Care Homes for Older People Page 20 of 23 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 21 of 23 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 1 7 The service should ensure that the reviews of individual plans do take place at least once a month, and that the plans show evidence that they have been agreed with the resident or family. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!