CARE HOMES FOR OLDER PEOPLE
Halwill Manor Nursing Home Halwill Beaworthy North Devon EX21 5UH Lead Inspector
Adele Adams Announced Inspection 18th October 2005 10:00 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 Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 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. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Halwill Manor Nursing Home Address Halwill Beaworthy North Devon EX21 5UH 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) 01409 221233 01409 221265 Mrs Jacqueline I Mirjah Mrs Jacqueline I Mirjah Care Home 25 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13), Old age, not falling within any other category (25) Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 5/8/1997 The maximum number of placements including that of the named individual, will remain at 25 To admit one named service user, named elsewhere, outside the categories of Registration as detailed in the Notice dated 4th August 2005.. 26th January 2005 Date of last inspection Brief Description of the Service: Halwill Manor is a privately owned care home registered to provide care for 25 patients. It is located in the heart of Halwill and has strong links with the local community. Halwill Manor is set back off the road and is situated in large and accessible grounds. Parking is provided and access to the home is level. The house is old and large, it has been adapted to suit the needs of people with mobility problems and care needs. There is a lift to help those with limited mobility access all floors. On the ground floor there is a large lounge and dining room; a smaller sitting area is adjacent to the main lounge off which are two offices. Two kitchens, a laundry, sluice room, staff rest room and some patient rooms are also on the ground floor. Home cooked meals are cooked on site. Activities and entertainment are arranged for patients. The atmosphere at Halwill Manor is relaxed and friendly yet professional. A qualified nurse is on duty to oversee the patients nursing needs 24 hours a day. The staff work hard to provide a homely environment whilst also striving to deliver quality care to Patients. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has introduced “Key Standards “ to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that all reports written within an inspection year (1st April to 31st March) be taken into consideration. This inspection was announced and took place between 10:35 and 16:20. During the inspection, the inspector spoke with and observed patients, staff, the owner and the administrator. The inspector toured the home, during which time staff and patients were observed and spoken with. The inspector also spent time reading documentation, which included; patient records, staff records, medication records, and policies and procedures. What the service does well:
This inspection found that patients at Halwill Manor are well cared for and live in a homely and caring environment. Patients receive care from staff that have access to good training opportunities, care is planned and overseen by qualified nurses. Patients feel they benefit from being at Halwill and enjoy the company and care of the staff. Patients are able to choose what colour they want their room to be and recently a patient had a new carpet in the colour of their choice fitted. This shows how patients’ views are valued and that Halwill Manor is recognised as their home. Staff value working with the patients, the open working environment at Halwill and the support they receive. Staff take up the opportunities to develop their knowledge and skills, which benefit the patients. The owner highlighted the importance of patients’ families should not be underestimated and that care at Halwill is tailored to the individual. The good
Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 6 working relationships with relatives and professionals such as, doctors and social services were also felt to have a positive effect fro both patients and staff. The owner also stated that the staff at Halwill are very good and are willing to develop. What has improved since the last inspection? What they could do better:
This inspection found that improvements are needed in the following areas: Care plan reviews should be undertaken every month, this will show that each patient has their needs reviewed at least monthly and will ensure that care given is up to date, monitored and appropriate.
Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 7 Further improvement to the recording of medicines received by the home from patients coming from hospital can be made which means there is an accessible record of medicines entering the home that will make sure that stock levels can be checked and accounted for. Further improvements to staff files are necessary; files must contain all essential information to ensure all necessary information about staff is easily accessible. Staff should receive Supervision 2 monthly; this provides important an important ‘one to one’ opportunity when staff can receive support or discuss any needs/ issues they may have which will also improve patient care. 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. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 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 Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Each patient at Halwill Manor has an assessment of his or her care needs before moving into the home showing that Halwill Manor was the right choice of home for them. No intermediate care is provided at Halwill Manor. EVIDENCE: The inspector read three patient records. The inspector saw evidence of social services care plans or Devon Shared Assessment Schedules – showing that needs assessment had taken place before admission to the home. The owner stated that in addition to this she visits patients before admission to undertake her own additional assessment. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 10 A care planning system is in place; this can be improved by increasing the review of care to monthly, which will demonstrate that regular monthly reviews take place as a minimum for all patients. The involvement and access to health care professionals and services is good, this reassures patients that there will be appropriate timely involvement of health professionals if and when necessary. Medication practices at the home have improved but need to improve further. EVIDENCE: The inspector read the records of three patients. This included reading of the patient care plans, each showed what care needs each patient had but the review of care was not taking place on a monthly basis – more detail could be provided in relation to social care needs. The senior nurse agreed that care plans had not been reviewed monthly and that this would be acted upon. The inspector read patient records, spoke with a patient and read appointment records, each of which clearly show that patients at Halwill Manor do have access to health care. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 11 The inspector revisited the documentation of patients’ medicines at the home following the previous requirement, the inspector saw records of the medicines that are delivered to the home and this is now able to be audited. The inspector was shown the medication returns book, which is used to show what medicines, have been returned to the pharmacist. The inspector saw an up to date list of all staff signatures for those staff that give patients their medicines. The home is to obtain a record book to show stock levels for patients’ medicines that are received by the home when a patient is admitted or returns from hospital. The inspector toured the home, read patient records, observed staff and patients and spoke with patients. This confirmed that patients at Halwill Manor are treated with respect and that their privacy and dignity is important to staff. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 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 the following standard(s): 12, 13 and 14 Routines and activities within the home are flexible and suited to patient’s needs. Patients are able to exercise choice and control over their lives and are able to maintain contact with family, friends and the local community. EVIDENCE: The inspector spoke with staff, read patients records and spoke with patients, both staff and patients described how they are supported and encouraged to make choices and gave examples of this – the patients care plans also highlight the preferences of patients. During a tour of the home the inspector observed that staff knock on the doors of patients rooms and wait before entering, the home make an effort to ensure those patients needing extra assistance or who have difficulty at mealtimes are provided with the opportunity of an alternative place to eat, showing that their dignity is respected. During the inspection the inspector spoke with visitors and a patient confirmed they are able to go out and take advantage of what is available in the local community – for example coffee mornings and confirmed that families take patients out, the mobile library visits the home for those that cannot access it themselves and some patients enjoy taking part in household activities. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 16 and 18 Halwill Manor has a complaints procedure, which gives relatives confidence that their concerns are taken seriously and will be acted upon. Some staff at Halwill Manor have attended formal adult protection training, this will risks to patients in the home. EVIDENCE: A complaints procedure is in place; it is available both on the notice board and in the service user guide and statement of purpose. A patient said they would go to the owner if they had a concern or complaint and that they have confidence that it would be dealt with. The inspector spoke with the owner, the new ‘manager’ of the home and two members of staff, 4 staff and the owner have now been on a recognised adult protection training course. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19 and 26. Halwill Manor generally provides a safe, comfortable, and clean environment for patients to live in. EVIDENCE: Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 15 The inspector toured the home and the majority of patient rooms were viewed. The patient rooms vary in size, the majority were personalised and furnished with patients’ possessions appearing homely and clean. There is access to all communal areas which include, the dining room, quiet lounge, lounge and conservatory. There is a lift for those with reduced mobility to enable access to upper floors. The home is well served with suitable washing facilities and lavatories, which are easily identified and conveniently situated. A couple of rooms visited by the inspector had a slight odour of urine – it was confirmed by the cleaners that these rooms had yet to be cleaned and that the carpets would be washed. The laundry has an industrial washing machine with a sluicing facility. The new manager described the process of handling soiled linen to the inspector, this was satisfactory, liquid soap and paper hand towels were available at each hand basin. Patients have their own linen basket to minimise personal laundry being misplaced. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Staff records need further improvement. EVIDENCE: Two staff files were inspected, each having 2 references and having undergone police checks, photographs were also included – the outcome of CRB checks on 2 staff were being awaited. However one member of staff who is now permanently employed at the home did not have a signed contract of employment on file– this was shared with the owner and administrator who will rectify this. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Halwill Manor does not yet have a registered manager, however, this inspection found that the home does appear to be run in the best interest of the patients and that the health and safety of patients and staff is important. Residents and staff at Pinehurst do not yet benefit from staff receiving regular supervision. EVIDENCE: An application to register a manager has been received but this is hindered, as the necessary CRB check has been unforthcoming – this was brought to the attention of the manager, owner and administrator during the inspection. Speaking with patients, observation of staff with patients and staff with visitors demonstrated to the inspector that the needs of the patients in the home and their visitors are the priority for staff.
Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 18 The inspector spoke with the owner, manager and staff and was advised that this has been addressed but is not happening on a 2 monthly basis. Health and safety was revisited in respect of the requirement made at the previous inspection in relation to fire doors being wedged open – this inspection found no evidence of this taking place. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 19 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X 2 X 3 Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP29 Regulation 17(2) Sch4 19(1)(b) Requirement The registered person shall maintain in the care home the records specified in Schedule 4. This relates to the position held at the care home, the work performed and the number of hours employed each week and the dates on which work commences and ceases. A member of staff now employed permanently did not have this in place. This recommendation is carried forward from the previous inspection. 2 OP31 8 The registered provider shall appoint an individual to manage the care home where there is no registered manager in respect of that care home. This relates to the absence of a registered manager. This Requirement is carried forward from previous inspections. 31/12/05 Timescale for action 31/12/05 Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 21 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 Refer to Standard OP7 OP9 OP36 Good Practice Recommendations The monthly review of care should be clearly recorded. This recommendation is carried forward from the last two inspections. There should be a clear record kept of all medicines received by the home. The registered person should ensure that staff receive formal supervision at least 6 times a year. This recommendation is carried forward from the previous two inspections. Halwill Manor Nursing Home DS0000026717.V255006.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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