Inspection on 24/05/05 for Halliwell Nursing Home

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Halliwell Nursing Home 01/08/06

Halliwell Nursing Home 13/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Halliwell Nursing Home Kingswood Road Tunbridge Wells Kent TN2 4UN Lead Inspector Ann Block Unannounced 24 May 2005 10:00 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 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. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Halliwell Nursing Home Address Kingswood Road Tunbridge Wells Kent TN2 4UN 020 7396 6700 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Elizabeth Finn Homes Ltd Mrs Gilliam Pollock Forsyth CRH Care Home 50 Category(ies) of Old age (50) registration, with number of places Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26 October 2004 Brief Description of the Service: Halliwell Nursing Home is a purpose built building on three floors dating from the 1970’s with later additions.It is situated in a residential area of Tunbridge Wells a short walk from the Pantiles. There is easy access to public transport including a main line station. There is parking for staff and visitors to the front of the house. The home is in extensive grounds covering an area of up to 6 acres. A private physiotherapy clinic adjoins the home.Six bedrooms have their own access on to a secluded patio area.The home caters for 50 elderly and older frail service users. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Regulatory Inspector Ann Block who carried out an unannounced inspection of Halliwell between 11.35 am and 6.35 pm. Management, staff and residents agreed to speak with the inspector, both in groups and privately. Feedback from the inspection was given to the General Manager who assisted the process of inspection. The inspector is familiar with the service hence some judgements have been made combining information from previous inspections with comments from residents and staff and reflections of practice from this inspection. From speaking with residents and staff it was clear that the service has at its heart the welfare of residents living at Halliwell. Systems are geared to the needs of older with the aim of providing the best quality of life possible within a care setting. What the service does well: What has improved since the last inspection? Overall care planning and daily records by staff have greatly improved and offer a mechanism for residents care to be well met with changes known to Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 6 those providing this care. Work remains to further improve the system. Redecoration and refurnishing of the lounges and some bedrooms has enhanced the environment for residents. The system of obtaining references for new staff has been tightened up to ensure the recruitment system protects residents. Medication recording has also been tightened to ensure prescribers’ directions are met in practice. Staff have received advice from seniors to ensure residents dignity is maintained when recording in care plans and daily records. 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. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,6 Residents and others have full provision to obtain written and practical information about Halliwell to decide whether they wish to move into the home. EVIDENCE: Residents said they had been able to make a decision whether to come in to Halliwell. One said she had visited a number of homes with family but found Halliwell to offer the most friendly staff who smiled and gave good eye contact, a pleasant room, well decorated environment and staff who she felt knew what they were doing. She had been fully advised before admission about fees and charges including responsibility for payment of additional items such as hairdressing and chiropody. A statement of purpose and service users guide is readily available to any interested person with copies placed in the entrance hall. The documents have been updated to reflect recent organisational changes. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 9 A blank contract was seen which gave clear detail of rights and responsibilities. Residents spoken with were aware of the detail of the contract and felt that having such a contract gave greater security both for them and for relatives who might otherwise be anxious. Files seen included records of pre admission assessments. Information provided by a resident spoken with confirmed detail of the assessment as being accurate. Some information contained in pre admission information had not been included in the care plan although remaining relevant. Managerial staff visit a resident in their then place of abode. This assessment, together with the application form, gives a range of information to make a judgment whether Halliwell can meet assessed needs. A personal letter is sent following the assessment confirming that the home can meet need. Some information in the application form could usefully be included in the subsequent care plan. Respite care is offered as it is felt that this is a valuable service both to the older person and carers. One resident had stayed at Halliwell for periods of respite care then chosen to make the home her permanent residence. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11 Residents’ health and care needs are very well managed, improvements to supporting documentation would extend this to the non-medical aspect of care and support. EVIDENCE: Each resident has a plan of care which sets out a range of activities of daily living. The care plan is the underpinning documentation to promote consistent, personalised care to meet the current needs of each resident. Residents spoken to were aware of their care plans, one mentioning that it had been discussed with her. This resident felt that staff knew her needs well. Some information gained from reading pre-admission information she agreed was important to her but hadn’t been noted at that time by staff. Staff are aware that records must be an accurate account of events in line with Nursing and Midwifery Council guidance. Medical records, such as guidance on peg feeds, were very clear, personalised and detailed, similar work in other areas would be of positive benefit to residents. Significant work has been carried out under the guidance of the Clinical Care Manager, further work in developing social and personal history would enhance opportunities to support residents in the non-medical aspect of their stay. Managerial staff were aware of this being an Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 11 area of current weakness and have asked the Social and Events coordinator to research and document these areas when working with residents. Residents felt that health care provision was excellent, both in house and in obtaining further medical treatment, both private and NHS. The home has the full support of General Practitioner’s, Consultants and general health care services. Records of medical care confirmed that relevant risk assessments such as nutrition, tissue viability, pressure wound and falls monitoring and mobility were actively addressed. Other areas of risk were not so well recorded. Residents spoke of having music and movement sessions which helped maintain mobility. Residents felt that one aspect of the home impressed them, being the ethos of respect for residents as people first recognising also their inherent rights to privacy and dignity. Staff were seen to knock on doors, a resident said staff routinely did this which she felt acknowledged this right to privacy. Residents said that they were asked how they wished to be addressed and this was normally followed in practice, a record of this would ensure all staff had similar knowledge. Residents are aware that they will be able to remain in Halliwell throughout all stages of older age, providing their needs can continue to be met. Discussion was held with staff about the depth of recording wishes in last stages of life and where such records could be accessed. There was an excellent understanding of action to take to ensure pain was well managed, physical and emotional comfort was promoted, with dignity maintained throughout. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12.13.14.15 Residents lead a life which as closely as possible matches their preferences, beliefs and social aspirations. EVIDENCE: The statement of purpose for Halliwell clearly states the status of persons who may be accommodated there. From this there follows an expectation from residents that certain social and cultural principles will be met. From speaking with residents and from previous experience of the home, this is fully acknowledged and excellently managed. Activities and social events are arranged by a designated social and events coordinator who at previous inspections has demonstrated her boundless enthusiasm for the role and a genuine interest in quality of life for older people. Details of a large range of activities was seen around the home and known by residents spoken to. Religious preferences are identified with external and internal contacts promoted. Residents spoke of family and friends visiting. A resident mentioned family being welcomed and able to stay for a meal. Continued contact with friends and social networks in the area is supported, one resident was hoping to be able to remain with two former societies she had belonged to. Where there is Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 13 limited access to personal support, the house committee can provide friendship and advocacy. Residents felt they were able to direct their lives but recognised there would be inevitable restrictions due to a group living situation. Comment was made that sometimes a buzzer seemed to take some time to be answered, but noted that is was usually during ‘peak’ periods. Staff were aware of individual preferences and built these into daily routines as far as possible. The home uses an external contract company which covers all catering and domestic responsibilities. Food provision is based on promoting interesting, well presented, varied and seasonal foods which meets dietary needs. Choice is offered and made known each day through the ‘Halliwell Times’. Residents were seen to be eating a variety of suppers including cold and hot foods, presented in a manner which was suitable for the individual. Encouragement is given to maintain a sound nutritional intake. A list of suggestions which could be made by staff to tempt a resident’s appetite was seen. Any assistance needed with eating is provided discreetly and on a one to one basis. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 Residents have good systems to make positive and negative comment about life at Halliwell to people who can effect change. EVIDENCE: Residents were aware they had the right to make complaint, to be listened to and for action to be taken. How to make complaint is presented in a clear, accessible policy with contact detail. The General Manager holds periodic meetings on a one to one basis with each resident as one forum to voice any concerns. One resident said she would probably speak through family at the moment. Residents had the opportunity to vote at recent elections either in person or by postal vote. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 Residents have a well maintained and decorated environment which meets their nursing and social needs. EVIDENCE: Residents felt overall the home was well maintained both mechanically and in décor. Redecoration and repairs are carried out on a planned and responsive basis. One resident spoke highly of maintenance services and was looking forward to having shelves put up in her toilet. Lounges have been redecorated and refurnished to meet the expectations and needs of residents living there. Taking into account the range of small and larger lounges and dining spaces there is ample room for residents to meet in small or larger groups and privately with family. Residents spoke of enjoying company in the large ground floor dining room for lunch where they could meet up with ‘friends’ and chat about the day. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 16 Plans are being discussed regarding general upgrading of the building to offer a more suitable environment for the generation of older people now coming into care. The main house is sited in grounds which offers access to smaller patios and a grassed area. The slope of the site offers good views over Dunorlan Park and the surrounding countryside. Each resident has their own bedroom, which whilst in the main is not large, has an en-suite, bed, clothes storage and easy chair. A resident had furniture and effects in her room which were treasured possessions with strong family connections and which she valued as part of her environment. Another resident much appreciated having her own TV and DVD player. A room key can be provided on request, each room has a lockable unit. A resident specifically spoke of the pleasures of having an assisted bath and being able to relax there with water up high which she loved. Over the past few years improved bath and shower arrangements have been made giving a range of facilities to meet individual needs and choices. Each room has its own ensuite, the majority have a washbasin in the ensuite, others have the basin in the sleeping area. Additional toilets are provided on each floor and accessible from communal areas. Staff have their own designated area and facilities. At some significant expense each room has been provided with an adjustable bed and pressure relieving mattress. A resident said she really appreciated having an electrical height adjustable bed and found she was sleeping much better than when she was at home. Her spoken sleeping preferences were confirmed in her care plan. Additional aids and equipment as required is either provided by the home or obtained through local health sources. Hoists have been purchased which are easier to use and which can weigh residents whilst being hoisted. A good sized lift given access to all areas used by residents. A nurse call system offers peace of mind. Individual preferences regarding room temperature and fresh air and managed by thermostatically controlled safe surface radiators and windows with restrictors. Residents are further protected from risk by monitoring of hot water at outlet. Residents considered the home was generally clean and mainly odour free. Comment was made that perhaps one recent employee wasn’t quite so committed to good standards of cleaning. Waste which might present a health and safety risk is removed safely. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected EVIDENCE: From responses given by residents and rosters on display, systems are in place to ensure residents’ needs are met by a mix of qualified and care staff with a strong commitment to specific and NVQ training. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 Residents benefit from a clear management and organisational structure which recognises the expectations of older people needing nursing care. EVIDENCE: Residents can be assured that the staff structure of the home provides clear designated responsibilities for overall and task specific management. Those staff in positions of responsibility have the experience and qualifications necessary for their roles including a registered nurse status or NVQ 3. The organisational structure gives upper lines of accountability with the General Manager holding direct day-to-day responsibility for Halliwell. Staff were clear that the final judgment over day to day matters were those of the General Manager, but within this structure held areas of designated responsibility such as heath and safety, tissue viability and falls management. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 19 All staff are expected to work in a professional manner, action will be taken where performance does not meet expected standards. Regular meetings are held including residents meetings, staff and Heads of Department. Minutes of such meetings are available as necessary. Mention was made of a requested change regarding use of a small lounge arising from a residents meeting the previous day and how this was to be actioned. Organisational changes have recently been made to ensure the continued viability, financial support and investment into services. Systems are in place for residents to have money held safely if they wish. Plans are in hand for the organisation to carry out financial audits which will include residents accounts. Proper insurance cover is taken out to protect residents and staff. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 3 x x x x x Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 21 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 Regulation Requirement None from this inspection Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP3.4 OP7.1 OP7.3 OP7.6 Good Practice Recommendations Pre admission information, including information from the placing agency, should be integrated into the initial care plan. Care plans should include residents social and personal history Work should be carried out to develop the risk assessment process to include all areas of risk which are recorded and accessible to those with a need to know. Consideration should be given as to the manner in which evidence is available that the care plan has been drawn up with the involvement of the service user and that a current copy is available in a format which is accessible to them.This remains a recommendation from the inspection of 26/10/04 – the format is now in hard copy and could be made available, work is underway to involve service users and family if appropriate and how to evidence this. A washbasin should be provided in each en-suite facility.This remains a recommendation from previous inspections. Consideration should be given to an independent audit H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 22 5. 6. OP21.5 OP35.1 Halliwell Nursing Home 7. OP37.1 being carried out as service users monies are normally dealt with by one person.This remains a recommendation from the last four inspections, a process by which this will be carried out is planned. Close monitoring of application and return of Criminal Records checks should be carried out. Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 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 Halliwell Nursing Home H56-H06 S64706 Halliwell V226085 240505 Stage 41.doc Version 1.30 Page 24 - 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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