Inspection on 29/03/07 for Halwill Manor Nursing Home

This inspection was carried out on 29th March 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Halwill Manor Nursing Home 31/07/07

Halwill Manor Nursing Home 13/06/06

Halwill Manor Nursing Home 13/03/06

Halwill Manor Nursing Home 18/10/05

Halwill Manor Nursing Home 26/01/05

Halwill Manor Nursing Home 25/05/04

Halwill Manor Nursing Home 20/01/04

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

CARE HOMES FOR OLDER PEOPLE Halwill Manor Nursing Home Halwill Beaworthy North Devon EX21 5UH Lead Inspector Susan Taylor Key Unannounced Inspection 09:30 29th March 2007 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.V330547.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. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 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 Clare Grace James 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.V330547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home will provide nursing care in the categories DE(E), OP, MD(E) To admit one named service user, named elsewhere, outside the categories of registration, as detailed in the Notice dated 28th September 2006. On termination of their residency, the home will revert to the registered categories and the Registered Person must notify the Commission of the fact 13th June 2006 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. The fees range from £306 - £600 per week and exclude the cost of hairdressing (£6.00), toiletries (£25.00 per month) and newspapers (variable). Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, carried out on the 29th March 2007 beginning at 9:30 a.m. lasting approximately 9 hours. The inspection included a full tour of the home and discussion with several staff including the provider, care staff, registered nurses, the cook and maintenance person. The Inspector also spoke to a number of residents and two relatives who offered their opinions on the food, the environment and staff who work at the home. At the same time, the Inspector observed care practices at staff delivered care to residents. Surveys were sent to five residents, five staff and four health and social care professionals. Comments from one member of staff and a health and social care professional are incorporated within the report. In summary, residents comments included “what would I have to complain about, this is a wonderful home. It is truly a home from home”. Visitors said “[Halwill Manor] has a good reputation in the village”. They went on to say that the provider had made them feel welcome at the outset by saying “this is [their] home as well as yours” and “they’re so caring, so gentle, so kind and so sweet. This place is everything I hoped for.” A professional wrote “I think it is an excellent care facility, where the staff clearly care a great deal about the residents” and “I receive excellent informal feedback from relatives regarding the care of family members at Halwill Manor”. What the service does well: What has improved since the last inspection? The Commission decided that the manager had good references and was suitably qualified and experienced to manage the home. The manager has now been registered. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 6 The manager and provider have improved the frequency of supervision of staff, which helps them to work safely and provides them with support and guidance so that they improve their practice and give the best possible care to residents. The management of health and safety issues has improved, which will safeguard residents, staff and visitors - regular checks of the fire alarm had been carried out and were recorded in the fire log. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Halwill Manor has a good admission procedure that is risk based and establishes at the outset individual needs so that these are well known by the team delivering care. This could be improved further to include assessment of individual nutritional needs using a recognised tool. The home does not offer intermediate care, therefore no judgement has been made about this. EVIDENCE: Three residents files were inspected. Nursing staff told the inspector that either the manager or registered provider assessed prospective residents prior to admission to ensure that their needs could be met at the home. Comprehensive assessments were seen on all the files, which also identified Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 9 risks with regard to tissue viability, falls, manual handling, continence and mental health issues. All of the assessments had been regularly reviewed. Whilst the home has a policy and procedure on food safety and nutrition it does not deal with the complex needs of some of the residents currently residing in the home. Two residents with complex needs had not had their nutitional needs assessed using a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). The provider told the inspector that the home does not offer intermediate care. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Halwill Manor has a good care planning process that provides clear information about the needs of the residents and how they are to be met. The home maintains good professional relationships with specialist people and implements their advice to the benefit of the residents. The current recording system for medication is confusing, open to errors and needs to be reviewed to ensure that residents receive the right medication, as prescribed, at the right time. Staff deliver care to residents in a respectful way that maintains their dignity. EVIDENCE: Three care files were inspected and had been regularly reviewed. Desired outcomes were clearly stated, providing achievable goals. Three residents needs were tracked and particularly focussed on the outcomes of care in respect of their nutritional, mental health and continence needs. Each person had a nominated key worker whose responsibility it is to ensure that the care Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 11 plans are current and the identified needs met. Residents and relatives told the inspector that they were consulted about their care needs and therefore involved in the care planning process. One person said “The help me with whatever I want them to do”. The inspector saw evidence on service users files that verified that the home has a professional relationship with the general practitioner with whom all the residents are registered. In addition to this there are good links with the mental health and social services teams. In a survey a healthcare professional verified that the staff always sought their advice and acted upon it to manage and improve individual’s healthcare needs. In the case of the three service user’s, the inspector saw records that demonstrated that specialist’s had been consulted and their advice implemented. These included a dietician, nutritionist, continence nurse specialist, community psychiatric nurse and PEG feed advisor. Additionally, the professional felt that the home always met individual’s needs and respected their privacy and dignity. This staff team were observed planning or providing care to residents in a manner that preserve their dignity such as in their own rooms or in an appropriate rooms such as the bathroom. Residents also have their own clothing on that is laundered by the home. Consideration had been made about how residents prefer to be addressed and staff was seen to communicate with the residents by that name. The inspector observed the nurse administering medication during lunchtime. Good practice was seen. At the time of the inspection, two surgeries dispensed medicines for residents. However, the nurse in charge told the inspector that the team had decided to move over to a monitored dosage system and would therefore be changing it’s supplier. One of the trained staff is responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. The system was easy to audit and the inspector tracked medication administered to three residents. Two records accurately reflected medication having been administered as prescribed by the GP. However, another record was inaccurate. According to records seen, procyclidine 5mg (to be taken twice a day) had been given to the resident three times a day between 19th and 26th March 2007. For the same person, Lorazepam 1 mg (to be taken twice a day) had not been given a night. The current recording system links an alphabet list of medication to a separate record that is completed everytime medication is given to the individual resident and is denoted by a letter rather than the name of the medication. The inspector discussed these findings with the nurse in charge who verified that the home had policies and procedures in place in the event of medication errors. The nurse expressed the view that the medication had been given as prescribed because people always checked the label on the individual’s medication and therefore felt that it was a recording Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 12 error. On the basis of probability and having reviewed other care records for the individual concerned, the inspector accepted this explanation having found the recording system somewhat confusing and open to recording errors. The provider told the inspector that the recording system would be changing as part of the move to another supplier and monitored dosage system. All medication was kept in a secure place. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines and activities are flexible and suited to individual residents needs. Residents are enabled to exercise choice and control over their lives whilst at the same time encouraged to maintain contact with friends and family in the community. Nutritional and personal preferences of residents are well met. EVIDENCE: The inspector had a discussion with four residents and two relatives and was told that activities, food and links with the community are “very good”. Individual care records detailed age appropriate and religious activities that were of interest to them. The inspector was told that “several people like to attend the church opposite the home”. A resident told the inspector “we can do what we want to when we want to” and went on to say that the home had a well stocked library of large print books that they enjoyed reading. The home advertised hairdressing sessions, which a resident verified did happen and told the inspector “you can have your hair done if you want to”. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 14 The inspector saw that the home has plenty of resources and suitable equipment to allow them to vary the planned and spontaneous activities that happen at the home. Staff told the inspector that bingo and quiz sessions are held every week and this was verified by two relatives who were visiting at the time of the inspection. Lunch was served during the inspection, which was well balanced, appetising and offered two choices. The cook had creatively incorporated plenty of fruit and vegetables into all three courses and sought informal feedback from residents throughout the meal. The Inspector observed the care of two residents during lunch. One person had nutritional supplements via a PEG feeding tube. Staff involved with this verified that they had received training to undertake this task. The other person needed to be fed. This was done by a carer who focussed all their attention on the individual concerned chatting with them, gently explaining what was on the plate and at a pace that suited the resident. The inspector saw that equipment such as plate guards were used that enabled some residents to continue feeding themselves without assistance. A visitor told the inspector that since admission their relative had put on weight and looked “much healthier because of the wonderful food they get”. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Halwill Manors arrangements for the protection of vulnerable adults, including dealing with complaints generally ensure that residents are protected and able to voice their concerns. EVIDENCE: Halwill Manor has a complaints procedure that was displayed on the noticeboard. Additionally the complaints procedure is summarised in the ‘service users guide’. Residents who were spoken to during the inspection verified that if they did have a complaint it would be dealt with promptly by either the manager or provider. The inspector received no complaints during the inspection and one resident said “what would I have to complain about, this is a wonderful home. It is truly a home from home”. Whilst touring the home the inspector saw that a bolt on the outside of bedroom door [room 14, first floor] had been removed as required following the last inspection. The inspector saw a copy of the ‘Alerters guide’ and whistleblowing policy. Kind and caring interactions were observed throughout the day between staff and residents. Staff engaged positively with residents Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 16 who had dementia and demonstrated a high level of skill in engaging those individuals. A relative told the inspector that the staff were “wonderful and caring”. Another visitor commented that their relative seemed so contented and said “she trusts them”. Four staff spoken to and one who responded by survey had a clear understanding about recognising abusive practice and what steps they needed to take if they should witness an incident. The provider verified that they and four other staff had attended recognised training on adult protection matters. Additionally, a high percentage of care staff had either completed or were in the process of completing the national vocational qualification in care, of which a component module is about abuse and adult protection. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at Halwill Manor live in a safe, comfortable and clean environment. EVIDENCE: The inspector toured the premises and saw that radiator guards were in place throughout the building. Fire exits were clear and accessible. All the bedrooms were inspected and found to be clean, individualised and comfortably furnished. Ensuite facilities had been fitted in a ground floor double bedroom. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. The dining room had been decorated and new flooring fitted. Maintenance certificates were seen for the lift, assisted baths, electrical installation, central healting and fire alarm Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 18 systems. The provider told the inspector that alterations to the kitchen were about the commence to extend and improve the facilities. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed as staff were seen to deliver care to residents. The laundry was clean and well organised. Infection control measures in respect of soiled linen were evident when the inspector spoke to staff about practices in the home. Sluices were clean and fully operational Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Caring staff, in sufficient numbers ensure that residents needs are well met. Recruitment practices at Halwill Manor are still poor and therefore fail to protect residents. The home has a training and development culture that ensures competent and knowledgeable staff care for residents. EVIDENCE: Duty rosters for the weeks beginning 1st January, 29th January, 5th February and 26th March 2007 were examined. The manager works four out of seven days. The inspector saw that there will always five or six staff on duty in the morning, four or five in the afternoon and through the evening. Additionally every day there is a cook and two domestics working eight till 2:30 p.m. maintenance is carried out by four people who cover five out of seven days a week. The provider has contracted 53 hours per week for maintenance of the home. There is a diverse staff team at Halwill Manor, with a gender mix that is consistent with the resident group. Requirements in respect of recruitment practices were followed up. The inspector examined the files of four newly Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 20 recruited staff. Of those, appropriate written references [two] had been obtained for two staff. However, these had been obtained for after the individual staff had commenced duties in the home (verified by duty rosters as above). Records of verbal references were seen on two other files. With exception of one file, criminal records bureau certificates had been obtained by the home. These shortfalls were discussed with the registered provider who told the inspector that long term sickness in the team had impacted upon their performance to address the requirements made at the last inspection. The inspector showed the provider the Commission’s publication ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf] and clarified what constitutes good practice in relation to recruitment procedures. The provider told the inspector that both they and the registered manager would address the shortfalls and oversee the recruitment process as a priority. Six staff were spoken to during the inspection. All of the staff verified that they had had manual handling training. In addition to this some of the staff had attended a dementia awareness training day. Care staff verified that training was regularly offered to them. Records also demonstrated that the professional development of nursing staff was encouraged to ensure that PREPP requirements are met. In a survey and nurse verified that the care home provided funding and time for training. Additionally, the individual felt well supported and kept informed of important developments by the manager and provider. Certificates were seen on the files, which included infection control and wound management. Staff records examined showed that 3 x Carers had completed NVQ level 2, 2 x Carers – are doing NVQ level 2, 1 x Carer – has completed NVQ level 3, 1 x Carer – is doing level 3 and 1 x Carer – is doing the assessor’s award. In a survey a healthcare professional felt that the care staff always had the right skills and experience to support individual’s social and healthcare needs. At the same time, the professional felt that diversity issues such as race, ethnicity, age, disability, gender, faith and sexual orientation were always well met for residents. Five staff verified that regular supervision and appraisals had been implemented. Recent supervision had been recorded on all files had been examined. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 21 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, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager and provider are experienced and qualified to run the home and do so effecively for the people who live there. Quality assurance systems tend to be informal and it is evident that resident’s, staff and visitor’s views are respected in this home. However, this is an area that needs further development so that outcomes for people who use the service are collated and reported upon to meet the current legal requirements and good practice. Financial procedures safeguard residents’ interests. The level of supervision and appraisal has increased in the home and should improve the care outcomes for residents. The provider is aware of the record of induction training provided for staff does not meet national minimum standards. Health and safety issues are managed effectively and which leave residents, staff and visitors at risk. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the previous inspection, the Commission had registered the manager who is a registered nurse with managerial experience. The provider told the inspector that herself and the manager were still doing the Registered Manager’s Award and hoped to complete it by the end of the year. The Cook told the inspector that waste was monitored and was seen seeking verbal feedback from residents at lunch. A resident told the inspector that meetings used to be held with them but non recently. The provider told the inspector that there was no formal quality assurance system. However, there was evidence of some auditing systems. An audit of health and safety had been carried out by a specialist company. In a survey a healthcare professional wrote “I think it is an excellent care facility, where the staff clearly care a great deal about the residents” and “I receive excellent informal feedback from relatives regarding the care of family members at Halwill Manor”. Similarly, a member of staff wrote “I feel that the residents receive good nursing care. We rarely have bed sores of any kind. The residents are well fed and receive adequate fluids”. A visitor told the inspector “[Halwill Manor] has a good reputation in the village”. They went on to say that the provider had made them feel welcome at the outset by saying “this is [their] home as well as yours”. Another visitor said it had changed [their relative’s] life, “they’re so caring, so gentle, so kind and so sweet. This place is everything I hoped for.” Records showing how money is managed on behalf of residents were inspected. These were well kept, and accurately recorded the correct balance seen. Entries had been signed for. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities are used to safeguard resident’s money. Six staff files were inspected to establish whether new staff had received an induction that met national minimum standards. Two out of the six files had a record of induction training that met Care for Skills Induction Standards. Five staff told the inspector that they had been given an induction to the home, which consisted of shadowing senior staff and being assessed as being competent to undertake certain tasks. The inspector spoke to the provider who was aware that the current records of induction did not meet national minimum standards. The inspector was told that the manager was in the process of implementing a new induction based on ‘Care for Skills’ induction standards and that every member of staff would have an induction assessment booklet. It was evident that the level of one to one supervision and appraisal had increased since the last inspection as this was recorded in the files examined. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 23 Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. A member of the team told the inspector that they had completed a Health and Safety course to NEBOSH standards. Certificates seen on files examined verified that staff had attended infection control and manual handling training in the past 12 months. The inspector observed hand sanitizer being used by staff to minimise the risk of cross infection. Records of accidents were kept and showed that appropriate action had been taken. The fre log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. Residents, relatives and staff told the inspector that the alarm was regularly checked. Certificated evidence verified that the hoists had been regularly maintained. First aid equipment was clearly labelled. Some of the staff on duty verified that they held a current first aid qualification. Good manual handling practice was observed as carers transferred residents from wheelchairs to chairs in the dining room at lunchtime. One wheelchair did not have footplates on it, and once this was pointed out to a carer was quickly rectified. Electrical appliance checks and risk assessments had been reviewed since the last inspection. Data sheets were in place and staff spoken to understood the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 24 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 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 3 Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 25 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 19 (1)(b)(i) Requirement The registered person shall not employ a person to work at the care home unless - subject to paragraph (6), (8), (9) her has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2. This relates to four files that were examined and discussed with the registered provider and a future recruitment practice forthwith. Timescale for action 31/05/07 Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 26 2. OP33 24(1,2) The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. (2) At the request of the Commission, the registered person shall supply to it a report, based upon the system referred to in paragraph (1), which describes the extent to which, in the reasonable opinion of the registered person, the care home— provides good quality services for service users; (b) takes the views of service users and their representatives into account in deciding— what services to offer to them, and (ii) the manner in which such services are to be provided; and has responded to recommendations made or requirements imposed by the Commission in relation to the care home over the period specified in the request. This relates to setting up a recognised Quality Assurance system to have benchmarks that are measurable and determine areas that have improved or need improving and includes detailed action plans and timescales. 31/08/07 Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations Nutitional needs of residents should be assessed using a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). Review the current recording system to ensure that there it is possible to audit who, when and what medication has been given to residents. Use the CSCI publication ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ (available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf) as good practice guidance for recruitment practices. Induction records kept in staff files should follow the ‘Care for Skills’ induction standards, including an assessment of competency by a suitably qualified person. 2. OP9 3. OP29 4. OP36 Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Halwill Manor Nursing Home DS0000026717.V330547.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!