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Inspection on 06/03/08 for Honeywood House Nursing Home

Also see our care home review for Honeywood House Nursing Home for more information

This is the latest available inspection report for this service, carried out on 6th March 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.

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

The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. Residents` needs are being met with the information provided in the care plans on the assessed needs of individuals and residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents are generally safeguarded by the medication procedures in place. Residents` privacy and dignity are respected. Residents` lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. Residents` benefit from an open culture where they are able to express their views and feel valued and protected from harm. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. Residents benefit from being supported by an experienced and committed team of staff and are generally safeguarded by the recruitment procedures. Residents` needs are being met with the number and skill mix of staff on duty. Residents` benefit from the commitment of a skilled and experienced Registered Manager who ensures that the home is managed and run in the interests and safety of the people who live there. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable.

What has improved since the last inspection?

No requirements were made at the last inspection. Work has been done and continuing to be undertaken to address any shortfalls noted throughout the content of the last report to improve the standards of services provided to residents. A number of environmental improvements have been made since the last inspection, which has created a more homely and pleasant feel. This included redecoration in some areas and providing ramps/rails to provide easier access for residents to the outside gardens.

What the care home could do better:

Although the Responsible Individual is at the home on at least a daily basis, albeit not in day to day control of the service, the Registered Provider must ensure the Responsible Individual or other allocated person undertakes Regulation 26 visits and prepares a report for the manager, to ensure they are made aware as the responsible person that the service is meeting its legislative requirements and aims and objectives. It is recommended that all handwritten prescriptions be checked and signed by two staff who have received medication training to further safeguard residents and other colleagues from errors occurring. Consideration must be made to ensure the conservatory is suitable for use by the service users, particularly if this area is included in the communal space that is required to be provided to residents. Further work is needed on implementing a quality assurance and quality monitoring system to evidence that the home is run in the best interest of residents. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made, have been highlighted throughout the report of which the Registered Manager will address. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Honeywood House Nursing Home. It provides the CSCI with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months.

CARE HOMES FOR OLDER PEOPLE Honeywood House Nursing Home Rowhook Horsham West Sussex RH12 3QD Lead Inspector Jennie Williams Unannounced Inspection 6th March 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Honeywood House Nursing Home Address Rowhook Horsham West Sussex RH12 3QD 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) 01306 627389 01306 627599 Trustees of Honeywood House Sandra White Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: Honeywood House Nursing Home is a care home providing personal care and nursing care for twenty-eight (28) older persons. The home is situated in a rural area near the village of Rowhook on the borders of West Sussex and Surrey. The home is a large converted and adapted 18th century mansion house standing in 10 acres of park and woodland. There are no local amenities within walking distance of the home. There is no access to nearby public transport, except taxis, however there is car-parking available at the home. The residents accommodation is located over two floors and consists of twenty-eight single bedrooms, six offering en-suite facilities. Five of the en suite facilities include a bath, however these are not in use due to the accessibility for the residents currently residing in the rooms. The home only accommodates 26 residents at any given time due to two of the bedrooms being only accessible by steps. There is a passenger shaft lift that accesses all floors. The communal space consists of two lounge areas, a conservatory and a dining room. The home has formal and informal gardens that are well maintained with most areas accessible to residents. There are suitable numbers of toilet and assisted bathing facilities located throughout the home to meet the needs of the residents. Weekly fees range from £640 to £730 per week. There are additional fees; hairdressing, chiropody, newspapers/magazines, dry cleaning and personal toiletries (at cost). This information was provided to the CSCI on the 06 March 2008. Prospective residents find out about the home through social services referrals, word of mouth and from themselves/relatives living in the area. Honeywood House Nursing Home DS0000024157.V359365.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. It should be noted that following recent CSCI consultation, it was identified that service users prefer to be called people who use services. It was confirmed that the home uses the term residents. For the purpose of this report, people who use the service will be referred to as residents. This unannounced site visit took place over seven hours on the 06 March 2007. Evidence obtained at this site visit and information that the CSCI have received since the last inspection forms this key inspection report. Five residents were spoken with individually. All 16 residents eating in the dining room at lunchtime were met and advised to let the Inspector know if they wished to speak with her individually. One resident did not wish to speak to the Inspector and this was respected. Ten resident surveys were sent to the home prior to the site visit, of which seven were returned. Six of these identified that the surveys were completed with help from a relative or representative. One care plan was viewed with the individual, with their permission. Specific areas of care were viewed in a further four care plans. Ten staff surveys were sent to the home prior to inspection, of which seven were returned. Five staff were spoken with throughout the site visit. Discussions were also had with the Registered Manager and Responsible Individual. Three staff files were viewed. A GP was spoken with during the site visit. A tour of the environment was undertaken and some individual rooms were viewed, with the resident’s permission. Medication procedures were inspected. Results of the last quality assurance surveys were viewed. The handling of complaints to the home was discussed. An Annual Quality Assurance Assessment (AQAA) was sent to the home prior to the site visit. This was to obtain information about the establishment to assist CSCI in the inspection process. Health and safety records were not viewed as this information has been provided in the AQAA. There were twenty-five residents residing at the home on the day of the site visit. Two in receipt of personal care only and all other residents required nursing care input. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 7 Although the Responsible Individual is at the home on at least a daily basis, albeit not in day to day control of the service, the Registered Provider must ensure the Responsible Individual or other allocated person undertakes Regulation 26 visits and prepares a report for the manager, to ensure they are made aware as the responsible person that the service is meeting its legislative requirements and aims and objectives. It is recommended that all handwritten prescriptions be checked and signed by two staff who have received medication training to further safeguard residents and other colleagues from errors occurring. Consideration must be made to ensure the conservatory is suitable for use by the service users, particularly if this area is included in the communal space that is required to be provided to residents. Further work is needed on implementing a quality assurance and quality monitoring system to evidence that the home is run in the best interest of residents. Any minor shortfalls noted at the site visit, of which no requirement or recommendation has been made, have been highlighted throughout the report of which the Registered Manager will address. The AQAA received from the home evidences that the home is working to improve the quality of the service provided at Honeywood House Nursing Home. It provides the CSCI with information on areas that have been improved in the last twelve months and what their plans for improvement are within the next twelve months. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home. The pre admission process ensures that only residents whose needs can be met at the home are admitted. EVIDENCE: There is a Statement of Purpose/Service Users Guide available upon request at the home that provides prospective residents/representatives information about the care and facilities provided at the home. It was confirmed that these documents are currently being updated with the correct contact details of the CSCI, as recommended at the last inspection. The most recent CSCI inspection report was noted to be located at the entrance of the home, along with information regarding advocacy services. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 10 The Registered Manager or a registered nurse will undertake the pre admission assessment on all prospective residents. The last inspection identified that these assessments are detailed and informative. There have been no changes to the format used. A pre admission assessment was noted to be in place for a recently admitted resident. Prospective residents/representatives are encouraged to visit the home prior to moving in wherever possible. The first month is a trial period to ensure the home is able to meet the needs of the individual and that the individual is happy residing at the home. It was confirmed that the contract advises that the first four weeks is the trial period. Of the residents that were asked, all confirmed that they or a representative visited the home prior to moving in. All seven resident surveys identified that they received enough information about the home before moving in so they could decide if it was the right place for them. The Registered Manager confirmed that there was no one residing at the home from any minor ethnic/religious groups with any special cultural or religious needs. There is information accessible should any new resident have any specialist needs. The Registered Manager gave an example where a family had provided them with extra information regarding specific needs for an individual at the time of death. Staff spoken with confirmed that they felt all residents were appropriately placed and all their needs were being met. They confirmed that the Registered Manager takes appropriate action if someone’s needs change and can no longer be met at the home. The home does not have dedicated accommodation to provide intermediate care, however respite care is provided if there is a spare room available. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the information provided in the care plans on the assessed needs of individuals and residents/representatives are provided with an opportunity to be involved in the reviewing process to ensure choice and preference is taken into account. Residents are generally safeguarded by the medication procedures in place. Residents’ privacy and dignity are respected. EVIDENCE: The last inspection identified that care plans were detailed and informative and provided guidance for staff on how to meet the assessed needs of the individuals. Care plans were not viewed in detail, as there were no shortfalls noted at the last inspection and there has been no changes made to the format used. Specific areas of care were looked at for four residents. There was guidance for staff to follow specific to these needs. The Registered Manager and staff spoken with all confirmed that care plans are reviewed on a monthly Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 12 basis, with the involvement of the individual/representative to ensure choice and preferences are taken into account. A resident confirmed that staff discuss their care with them and they are familiar with their care plan. A care plan was viewed with an individual, with their consent. The resident confirmed that the information was generally accurate and specific to their needs. There was one need that they did not feel was exactly accurate. This information was shared with the Registered Manager to discuss with the individual. Of the staff that were asked, all confirmed that the care plans in use provided clear information and were user friendly. Three resident surveys identified that they always receive care and support they need, three identified they usually receive the care and one identified they sometimes receive the care and support they need. The Registered Manager confirmed that information is currently being accessed on developing advanced care plans to provide detailed information about how an individual wishes to be cared for at the end of their lives. There was evidence that additional equipment was in use to improve the communication between staff and a resident who had communication difficulties. A resident survey received, which was completed with assistance from a representative, identified that individual choices are respected. A written comment was “with our agreement one of the carers is doing communication skills with ….. as part of her [National Vocation Qualification] NVQ 2 in care”. The Registered Manager confirmed that the form for recording wounds has been expanded since the last inspection to provide additional information on the treatment and progress of wound healing. The home has access to pressure relieving equipment and specialist advice when the need arises. A visiting GP was spoken with who commented “the best home in the area for miles”. The GP confirmed that the home is pro active and seeks advice when needed. The home staff are very professional and he has no concerns regarding the practices within the home. Medication Administration Record (MAR) charts viewed demonstrated that medication is being signed for at the time of administration. Registered nurses administer medication. There were a few minor gaps noted in the MAR charts. No requirement or recommendation has been made in relation to this, as the Registered Manager is able to identify who was responsible and address it with the individuals involved. It is recommended that all handwritten prescriptions be checked and signed by two staff who have received medication training to further safeguard residents and other colleagues. Residents are provided with an opportunity to control their own medicines if they wish and a risk assessment identifies it is safe for them to do so. There was no one self-medicating at the time of the site visit. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 13 The home had notified the CSCI regarding a missing controlled drug. The home has taken appropriate action to address this error, although the missing tablet was unable to be located. Records and number of controlled drugs in stock were viewed that demonstrated accurate records are being maintained. It was confirmed that medicines are disposed of through a licensed company. It was observed that the fridge containing medicines was in a communal corridor and was unlocked. The Registered Manager confirmed that they are awaiting the lock to be fixed. It was advised that immediate action be taken to ensure secure storage of these medicines. No requirement was made in relation to this as the Registered Manager confirmed she will address it immediately. Residents confirmed that staff respect their privacy and dignity. Staff were observed to have a good professional rapport with residents and were seen to knock on room doors prior to entering and were heard calling residents by their preferred term of address. Six of the resident surveys received identified that the staff listen and act on what they say. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and are provided with opportunities to participate in activities if they wish to. Residents receive a choice of balanced and freshly prepared meals. EVIDENCE: Residents spoken with confirmed that their lifestyle within the home is their own choice. Residents were observed to move freely within the home on the day of the site visit. Most residents and staff spoken with confirmed that they felt there were sufficient activities provided at the home, should they choose to be involved. Some staff stated that some residents have expressed the interest in going outside more often. A staff member confirmed that no arranged outings are provided. The Registered Manager will look into this when the weather improves. One resident spoken with confirmed that she has been provided with an opportunity to visit the local town. Some staff commented that they would like more time to spend with the residents. The AQAA identifies that management has already identified providing more one to one activity with residents is an area that they could do better. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 15 Residents surveys identified that there were mixed feelings regarding the provision of activities. When asked if there are activities arranged by the home for them to take part in three identified always, two identified usually and two identified sometimes activities are provided. A written comment from a staff member stated “Entertainment and stimulation is provided every week for the residents. This could possibly be increased”. No requirement or recommendation has been made in relation to this, however management need to ensure they ascertain the wishes of preferences of individuals and take action if it is identified. A list of the activities on offer for the week was noted to be on display at the entrance of the home. A copy of a local magazine for the village is available at the entrance of the home to advise residents of events and local news within the community. A new vicar has been accessed and has arranged to visit the home once a month to provide a religious service for those residents wishing to participate. There are no restrictions for visiting times. Residents confirmed that their visitors can visit at any time and they are able to see them in private. One resident commented that they have friends that come for dinner at the home. The Responsible Individual was observed to interact and offer a glass of sherry to all residents prior to lunch. It was confirmed that this is a daily occurrence. Residents were observed to enjoy this routine and it was noted that the Responsible Individual has a good rapport with individuals. Residents spoken with were complimentary about the food provided at the home. There is no choice provided for the main lunchtime meal, however an alternative is served if the individual does not like what is on the main menu. Most residents confirmed that they have a choice provided with the supper. Five of the resident surveys identified that they always like the meals and two stated they usually like the meals provided at the home. The cook has a list of residents’ likes/dislikes/allergies to ensure food provided is suitable and within an individual’s choice and preference. Residents were observed to be enjoying their lunch. Work has been undertaken and is continuing to be done on upgrading the kitchen facilities. This work has been done with consultation with the environmental health authority and has been undertaken at times to ensure there are no disruptions to providing a service to the residents. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an open culture where they are able to express their views and feel valued and protected from harm. EVIDENCE: Residents spoken with confirmed that they would feel comfortable to raise any concerns and knew who they would speak to. The AQAA identifies that there have been five complaints made to the home within the last 12 months of which none were upheld. Records are maintained of all complaints. There is evidence that the home takes any concern seriously and takes appropriate action to address any issues. All seven resident surveys identified that they all know how to make a complaint and six identified that they always know who to speak to if they are not happy. All seven staff surveys identified that they know what to do if someone raises concerns about the home. Staff confirmed that they receive Safeguarding Adults training and are clear with the procedures to follow in the event of an allegation being made. The AQAA identifies that there have been no Safeguarding Adults investigations made in the last 12 months. Staff attend annual training in Safeguarding Adults. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 17 The AQAA identifies that within the last 12 months the home has introduced policies on bullying in the work place and harassment at work. Information is being obtained and introduced to staff regarding changes within the Mental Capacity Act. Management have updated other policies used to ensure staff and residents are safeguarded within current guidelines. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. EVIDENCE: Residents spoken with confirmed that they were happy with the environment and their individual rooms. Rooms viewed demonstrated that the rooms are personalised to reflect the individual’s choice and character. A tour of the environment was undertaken that demonstrated that the environment is comfortable for residents and there is ongoing maintenance within the service to improve these standards. Work has been done since the last inspection to improve the standards within areas of the home and provide easier access to the garden for the residents. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 19 All beds provided at the home are not adjustable, as recommended for people in receipt of nursing care. It was confirmed that adjustable beds will be arranged for those residents who require these facilities to assist staff in better meeting their needs. Staff confirmed that there are enough assisted bathing facilities provided within the home to meet the needs of the residents. Two out of the four communal toilets on the ground floor have been purpose built to provide enough room for the use of hoists if needed. One resident survey identified that some “toilets could do with better aids ie. Handrail or from around toilet.” The call bell system in place monitors the amount of time each call takes to be responded to, which the Registered Manager confirmed that she regularly monitors to ensure that assistance is provided to residents within a suitable time. All individual rooms were noted to be able to be locked. The Registered Manager confirmed that all staff are able to override these locks if they need to access the rooms in the event of an emergency. There is a pleasant conservatory on site, however it was observed and confirmed by staff that this is not used. It was noted to being used as a storage area. There were some old furnishings and wheelchairs being stored in this area. It was confirmed that this area was too hot in the summer and too cold in the winter for residents to use. Consideration must be made to ensure this area is suitable for use by the residents, particularly if this area is included in the communal space that is required to be provided to residents. The AQAA identifies that improving on soft furnishings is an area that they could do better and have plans for the this improvement in the next 12 months. The home was observed to be clean and free from offensive odours on the day of the site visit. It was discussed with the Registered Manager that the cleanliness under bath hoist seats could be improved. There is one sluice machine located at the home to assist in infection control. Personal laundry is done on site and other laundry is contracted out to an external company. There are suitable processes in place for the disposal of clinical wastes. The AQAA identifies that all staff have received training on the prevention of infection and management of infection control. Four of the residents surveys received showed that the home is always fresh and clean. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from being supported by an experienced and committed team of staff and are generally protected by the recruitment procedures. Residents’ needs are being met with the number and skill mix of staff on duty and are safeguarded by the recruitment procedures in place. EVIDENCE: Residents spoke positively about the staff working at the home. Comments ranged from ‘alright’ to ‘very nice and helpful’. One resident commented that staff are friendly and laugh a lot. Residents and staff all confirmed that they felt there were sufficient numbers of staff on duty at all times and there is good teamwork within the home. Staff shortfalls occasionally occur in the event of sudden illness with a staff member. This was also confirmed in staff surveys. The Registered Manager confirmed that there is generally six care staff on in the morning; three in the afternoon and two care staff working a waking night. There is always a registered nurse on duty. Management is also on duty during the week. The AQAA identified that temporary or agency staff have covered 73 shifts in the last three months. The home is in the process of recruiting new staff. Where agency staff are used, the home requests people who have worked at Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 21 the home on previous occasions to promote continuity of care. It was recommended that the home receive confirmation from the supplying agency that staff supplied to them have had all necessary recruitment checks undertaken. Recruitment files viewed demonstrated that residents are generally safeguarded, however further improvements could be made to ensure robust recruitment procedures are in place. Ensuring application forms are fully completed will assist in addressing the shortfalls. These should include detailed employment history ensuring any gaps in employment are explored and reasons for leaving employment obtained. Where possible, management should endeavour to access references from previous employers and not just character references. Enhanced Criminal Record Bureau (CRB) were seen to be in place and staff have at least a Protection of Vulnerable Adults (POVA) check in place checks prior to commencing work. It was confirmed that staff commencing work on a POVA check are supervised. It was discussed with the Responsible Individual that staff should only commence work with a POVA check in exceptional circumstances. No requirement has been made in relation to recruitment procedures, as the shortfalls were not consistent within all files. The AQAA identifies that all the people who have worked in the home in the past 12 months have had satisfactory employment checks. This includes a volunteer who works at the home. The AQAA identifies that there are 21 permanent care staff, with 11 having National Vocation Qualification (NVQ) or above and two staff are currently working towards these qualifications. The AQAA identifies that this training is continuing to be accessed for staff. A written comment from a staff member stated “I was encouraged to complete NVQ 2 having been in the job for less than a year”. Staff spoken with confirmed that they were provided with an induction at the commencement of employment, are up to date with mandatory training and were provided with enough training opportunities. Registered nurses receive additional training that are relevant to their roles and assist in maintaining their Nursing and Midwifery Council (NMC) registration. Six of the staff surveys identified that the induction covered very well everything they needed to know to do the job when they started. All seven staff surveys confirmed that they are given training that is relevant to their role, helps them to understand and meet the individual needs of residents and keeps them up to date with new ways of working. Management has identified dementia as a training need for staff, due to changes within individual residents, and will be accessing training in relation to this. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the commitment of a skilled and experienced Registered Manager who ensures that the home is managed and run in the interests and safety of the people who live there, however further development of the quality assurance system will assist with evidencing this. The health, safety and welfare of residents and staff are promoted and protected so far as is reasonably practicable. EVIDENCE: The Registered Manager is registered with the CSCI and has the suitable skills and experience to manage the service. She has current registration with the Nursing and Midwifery Council (NMC) and has completed the Registered Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 23 Manager Award course. She confirmed she keeps herself up to date by participating in external training and by reading a magazine designed for nurses. The service is run by a charitable trust. The Registered Manager confirmed that she is sometimes restricted in quickly updating information within the home due to the limitations as everything is done on a typewriter. Staff spoken with were complimentary about the management of the home. Staff confirmed that the Registered Manager and Responsible Individual of the services are both supportive and approachable. They confirmed that the Registered Manager was open to trying new ideas regarding working practices within the home if it can improve the outcomes for residents. Staff spoke positively about their enjoyment of working at the home and this was also observed throughout the site visit. Of the staff that were asked, all confirmed that there are clear roles and responsibilities within the home. An AQAA was completed as required, however discussions were had with the Registered Manager on how information could be expanded to provide more detailed evidence. Discussions were had with the Responsible Individual to consider providing the Registered Manager with a computer system to assist in easier record keeping and to provide better accessibility for the Registered Manager to keep herself updated with changes. The Registered Manager currently relies on her deputy to download up to date information from the internet. There is a planned quality assurance and quality monitoring system in place, however this is not currently being regularly put into practice. The home has received a quality assurance and quality-monitoring folder from an external organisation and proposes to implement these guidelines. Surveys will be implemented on a regular basis for residents, representatives, health professionals and staff. Discussions were had with the Responsible Individual and Registered Manager on ways to ensure that any results from their quality assurance process are made available to residents and other stakeholders. Results are currently shared with staff. No requirement has been made in relation to this as the home is taking action to ensure their quality assurance system assists in improving the outcome for residents. This will continue to be monitored throughout the inspection process. Minutes of residents meetings are available at the entrance of the home and these are proposed to be held twice a year, or more frequently if the residents wish. Staff meetings are held every two to three months. It was confirmed that the Responsible Individual speaks to residents on a daily basis. It was discussed with the Responsible Individual the requirement to undertake Regulation 26 visits and produce a report in respect of this to share with the Registered Manager. There were some Regulation 26 available for viewing, however these provided brief information and were not undertaken on a regular basis. The Registered Manager has not received any of these Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 24 reports. The Responsible Individual was advised to access guidelines regarding this regulation from the CSCI website. This will ensure that the registered provider is made aware as the responsible person that the service is meeting its legislative requirements and aims and objectives. The AQAA identifies that equipment in use is serviced or tested as recommended by the manufacturer or other regulatory body. Staff commented that the wheelchairs within the home could be better maintained. This was discussed with the Registered Manager who confirmed that she will address this. No requirement or recommendation has been made in relation to this, however will continue to be monitored throughout the inspection process. The AQAA identifies that there are relevant policies and procedures in place and these were last reviewed in 2007 to ensure they contain up to date guidance. It was observed on the tour of the premise that door wedges were noted to be in use. The Registered Manager confirmed that staff are aware of the additional risk this poses in the event of a fire. The Registered Manager confirmed that the use of door wedges has been discussed with a fire officer and is identified in their risk assessment. Management should consider implementing appropriate fire door guards to further protect staff and residents. No requirement has been made in relation to this as the local fire authority has been consulted on this matter. It was confirmed that all staff receive fire training and participate in fire drills. Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 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 3 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 26 Requirement That the Registered Provider ensures the Responsible Individual or other allocated person undertakes Regulation 26 visits and prepares a report for the manager, to ensure they are made aware as the responsible person that the service is meeting its legislative requirements and aims and objectives. Timescale for action 31/05/08 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. 2. Refer to Standard OP9 OP20 Good Practice Recommendations All handwritten prescriptions should be checked and signed by two staff who have received medication training to further safeguard residents and other colleagues. Consideration must be made to ensure the conservatory is suitable for use to the service users, particularly if this area is included in the communal space that is required to be provided to residents Honeywood House Nursing Home DS0000024157.V359365.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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