Inspection on 31/07/07 for Halwill Manor Nursing Home

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 29/03/07

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 Unannounced Inspection 10:00 31st July & 2 August 2007 nd 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.V343138.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.V343138.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.V343138.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 29th March 2007 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.V343138.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 of Halwill Manor under the ‘Inspecting for better lives’ arrangements. We were at the home for 11.5 hours meeting people that live at Halwill Manor, their relatives and staff working there. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. Additionally, we wanted to follow up whether legal requirements set out in the March 2007 report had been dealt with. The inspector looked at records, policies and procedures at the office. A tour of the home took place. Surveys were sent to ten people that live at Halwill Manor, twenty staff and seven health and social care professionals: 30 of the people living at the home; 40 of staff and 14 health and social care professionals responded to the survey. The comments of the people who responded are included within the report. Following the last inspection, the Commission drew up an improvement plan with the home that is a legal document. This covers two requirements made in the last report. Mrs Mirjah and Mrs James agreed to address all of the issues within certain timescales. One requirement about recruitment practices has been met. The other about formally seeking feedback from the people that live at the home, visitors and health and social care professionals is partially met. It was agreed that this requirement would be repeated and a new timescale given up to 31st January 2008. What the service does well: People living at Halwill Manor say that they are made to feel “very welcome” from their very first day living at the home. Important information is obtained about people prior to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet people’s needs. The vast majority of care plans are well structured around what each person wants from the team. The team of staff have good links with professionals, which helps to improve the health of people living there. People who live at the home say that the staff are very attentive. Their relatives are very satisfied with the care and also say that their relations are happy living there. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 6 People are treated as individuals. A relative told us “she is always made to feel good about herself because they help her maintain a good appearance” The staff are kind, caring and considerate towards the people who they look after. The home has an open feel. People living there say that they have the freedom to do what they want to, when they want to. At the same time, they are confident about the way staff protect their property for them. The also feel able to voice their concerns, if they have any, and know that these are taken seriously and looked into by the manager. Families and friends say that they are encouraged to visit whenever they wish to. The people living at the home get support to keep in touch with their families and friends if they need to. Relatives said things like “There is a convivial atmosphere, they’re good at the little things that matter like making people feel safe, happy, warm and well cared for” and “this is the best residential home around”. There is a good choice of appetising and well-balanced meals at Halwill Manor. People say that the choice is good and meals are “tasty” and are “always of good quality and plentiful. Halwill Manor is a spacious and comfortable place to live. At the same time, people who use wheelchairs or walking aids find it easy and safe to get around the home. People living there say that they are encouraged to see it as their own home and that it is always clean and reasonably well maintained. Staff feel well supported and are encouraged to do training so that they care for people properly. Written information about the people living at Halwill Manor is stored securely to maintain confidentiality. What has improved since the last inspection? What they could do better: Legal requirements have been made about: Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 7 Vulnerable people must be protected by ensuring that everyone is clear that bullying behaviour is totally unacceptable. We asked the provider to deal with this immediately. Make arrangements to enable people living in the home to be fully involved in improving the quality of the service they receive by holding regular meetings with them and their representatives. Additionally, carry out surveys with them, their representatives and professionals visiting the home. Summarise findings and set these out into a report, so that people can see how and within what timescales steps will be taken to improve the service. We agreed to repeat this requirement and extend the timescale. Recommendations have been made about: Some of the residents have complex nutritional needs. The home does not use a recognised tool to assess this to ensure that people get the right foods to keep them healthy. People living in the home should be involved in planning and reviewing their care to ensure that it meets their needs. People living in the home should be confident that all of the staff that administers medication to them does this safely by following Halwill Manor’s policies and procedures. Care plans should be reviewed when people return for respite care to ensure that staff have the most up to date information about people. People living in the home should be confident that all of the staff that administers medication to them does this safely by following Halwill Manor’s policies and procedures The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities would then be person centred and pitched at a level that is suitable for the individual. Ensure that other people in the home are not subjected to bullying behaviour, by carefully monitoring the situation and taking a proactive approach to stamping out such behaviour. Obtain a copy of the new safeguarding procedures from Devon County Council Use the Department of Health guide ‘Essential Steps’ to assess current infection control management to protect people that live in the home and staff that work there. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 8 People living in the home should be confident that that all of the staff has received infection control training and as a result implement best practice when caring for them. People living in the home should be confident that that all of the equipment used whilst caring for them is fit for the purpose and in full working order. The manager should implement a system of auditing and regular maintenance of equipment such as wheelchairs, pressure relieving aids and bedsides. 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.V343138.R01.S.doc Version 5.2 Page 9 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.V343138.R01.S.doc Version 5.2 Page 10 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): 3, 6 Quality in this outcome area is good. Halwill Manor establishes at the outset whether the team can meet a person’s needs. This could be improved further to ensure that people’s nutritional needs are assessed using a recognised tool. The home does not offer intermediate care; therefore no judgement has been made about this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were inspected. Important information is obtained about people prior to them moving in to the home. Comprehensive assessments were seen on two out of three files, which also identified risks that people might have with regard to tissue viability, falls, manual handling, continence Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 11 and mental health issues. Assessments had been regularly reviewed in two files. A person who was staying at the home for respite care did not have assessment information on file. Staff at handover verified that the individual concerned had dementia and verified that the person’s needs had changed since the care plans were last reviewed in August 2006 when they last stayed at the home. Entries in the individual’s care diary also verified this. On examination of another file of a person with complex nutritional needs their nutritional needs had not been assessed. A tool such as the ‘Malnutrition Universal Screening Tool’ (available at from www.bapen.org.uk) can be used for this purpose and a recommendation is made. The manager told us that the home does not offer intermediate care. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good Halwill Manor has a good care planning process that provides clear information about the needs of the people and how they are to be met. This had not been followed for a person returning for respite care. Staff did not have the most up to date information about the person. Therefore, the manager needs to ensure that the care planning process is followed consistently. Care is delivered to people in a sensitive way that promotes their dignity and privacy. The team works in partnership with other professionals to ensure that the healthcare needs of people are met. Procedures ensure that medication is stored and recorded in a manner that protects people by ensuring that they are given the right medication, at the right time. However, staff responsible for administering medication need to be made aware of best practice outlined in the procedure to avoid putting people at risk of being given the wrong medication. This judgement has been made using available evidence including a visit to this service. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 13 EVIDENCE: Three care files were inspected, two had been regularly reviewed. Desired outcomes were clearly stated, providing achievable goals. Each person had a nominated key worker whose responsibility it is to ensure that the care plans are current and the identified needs met. We observed care being delivered to these people, which was good. The third person whose care was tracked had dementia was staying for respite care did not have an up to date care plan. Staff at handover verified that the individual concerned had dementia and verified that the person’s needs had changed since the care plans were last reviewed in August 2006 when they last stayed at the home. The care files examined gave a comprehensive overview of the health needs of the individual’s concerned and, with the exception of one discussed above, acted as an indicator of change in health requirements. The home has a professional relationship with the general practitioner with whom all the residents are registered. In addition to this, we saw correspondence demonstrating that there are good links with the mental health and social services teams. Two relatives that we met said that they were “very satisfied” with the care their relative receives. Additionally, we were told that their relative’s health had greatly improved since moving into Halwill Manor. Correspondence on files and daily records verified that healthcare specialists had been consulted and their advice implemented. These included a dietician, nutritionist, continence nurse specialist, community psychiatric nurse and PEG feed advisor. Equipment, such as walking aids, wheelchairs and a PEG feed machine was seen being used by staff that were caring for the individuals concerned. This staff team were observed giving care to people in a manner that preserved their dignity such as in their own rooms or in appropriate rooms such as the bathroom. We saw that people were wearing their own clothing, which had been nicely laundered by the home. A relative told us “she is always made to feel good about herself because they help her maintain a good appearance” The staff are kind, caring and considerate towards the people who they look after. Two surgeries dispensed medicines to people. The provider told us that the team had looked into moving over to a monitored dosage system with a different supplier but given the rural location of the home it had proved to be impractical. 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 people. Records accurately reflected medication having been administered as prescribed by the GP. All medication Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 14 was kept in a secure place. We observed a nurse administering morning medication. Medication was ‘potted up’ enmasse in labelled pots on a tray then taken around the home and administered as prescribed for people. The inspector highlighted that this was not best practice to the nurse concerned due to the risk of being distracted and potential administration errors being made. However, the nurse concerned felt that given environmental constraints and number of people requiring medication in the morning it was the only way to manage this effectively. The policy and procedure on management of medication clearly stated that medication should be administered to each individual then a record made of it as opposed to ‘potting up’. This matter was discussed with the manager and provider who told the inspector that it would be addressed with the individual practitioner concerned. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good Routines and activities are flexible for people. Generally staff are aware of the need to support people to develop their skills, including social, emotional, communication, and independent living skills. Some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved for people with dementia or communication difficulties. People are encouraged to maintain contact with friends and family in the community, which demonstrates a commitment to the principles of inclusion. The food in the home is of satisfactory quality, well presented and meets the dietary and cultural needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had a discussion with people in the dining room over lunch and met two We observed how staff interacted with the people living at the home, Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 16 Particularly those with limited communication or dementia. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. However, group activities were geared towards the more able, leaving people with dementia disengaged. Records held about people did not include enough information about their social, economic and cultural histories. The manager understood that to achieve a fully person centred approach staff need in-depth knowledge about the people they care for such as their family and working history as well as their hobbies and interests. Additionally, people’s abilities had not been individually aassessed using a tool such as the ‘Pool Activity level instrument’. The service for people with dementia could be improved further if the team had such information because activities could then be pitched at the right capability and interest level for people. Lunch was served during the inspection, which was well balanced and appetising. We saw at least three different choices being served. The cook had creatively incorporated plenty of fruit and vegetables into all courses and sought informal feedback from people throughout the meal. People we spoke to made comments like “the meals are nice” and “they know what you like. There’s no choice at the main meal but they do something different if you don’t like it”. We also observed how staff supported people that needed help with eating their meals. One person had nutritional supplements via a PEG feeding tube. Staff involved with this verified that they had received training to undertake this task. We saw this feed being given and the staff talked directly at the individual concerned explaining every stage of the process. 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 person. The inspector saw that equipment such as plate guards were used enabling people to continue feeding themselves without assistance. A visitor told us that since admission their relative had put on weight and was healthier as a result. We examined three care files, which demonstrated that people’s weight is checked on a monthly basis. These records showed that people had either steady gained or decreased weight towards more healthier levels dependent upon their needs. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate Halwill Manors arrangements for the protection of vulnerable adults, including dealing with complaints generally ensures that people are protected and able to voice their concerns. The manager needs to ensure that information about safeguarding procedures is up to date. Management of bullying behaviour by people living at the home has been reactive. The manager and provider must protect the more vulnerable people by ensuring that everyone is clear that bullying behaviour is totally unacceptable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw the complaint procedure displayed on the noticeboard. Additionally the procedure had been summarised in the ‘service users guide’. People we spoke to told us that if they did have a complaint it would be dealt with promptly by either the manager or provider. During the inspection, we did receive some concerns about another person living at the home who was away at the time. People told us that they felt bullied by the person, who tended to take control of the television without consulting everyone else. Staff explained to us that they had intervened when they observed this and had asked the Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 18 person not to do this. We examined the individual’s care file, which demonstrated there was a clear strategy for dealing with the behaviour reported to us. Day to day records also verifed that action had been taken to manage the individual’s behaviour. However, we were of the opinion that this was somewhat reactive and there was no written evidence that the individual had been told that this was unacceptable. The matter was discussed with the provider who felt that the behaviour was unacceptable and told us that they had spoken to the individual concerned. However, there was no written evidence of this in the care file. When we returned to the home on the second day of inspection, the provider told us that they had arranged for the individual concerned to be assessed by the GP and had sought advice from the community psychiatric nurse. The provider assured us that the team would continue to carefully monitor the situation, intervening early and to make clear that this is unacceptable, so that other people in the home are not subjected to bullying behaviour. From our discussions with people and observations made we were left in no doubt that the provider and staff will not tolerate bullying behaviour in the home. We saw a copy of the ‘Alerters guide’, which was out of date. The home also had a whistleblowing policy, which all of the staff we spoke to understood. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people who had dementia and demonstrated a high level of skill in engaging those individuals. A relative told us that the staff were “kind and caring”. Another visitor commented that their relative was contented. Four out of five staff had attended recognised training about safeguarding people. Additionally, a high percentage of care staff had either completed or was 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.V343138.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is good People living at Halwill Manor live in a safe, comfortable and clean environment. The management has an infection control policy. They encourage their own staff to work to the home’s policy to reduce the risk of infection to people living in the home. This might be improved by auditing practice using a recognised tool such as the Department of Health guide ‘Essential Steps’ and encouraging all of the staff to attend training about the prevention of infection and management of infection control so that they develop knowledge and implement best practice when caring for people. This judgement has been made using available evidence including a visit to this service. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 20 EVIDENCE: We 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. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and homely. Maintenance certificates were seen for the lift, assisted baths, electrical installation, and central heating and fire alarm systems. Alterations to the kitchen had been completed, which extend and improve the facilities. With regard to infection control measures, the provider verified in the AQAA (Annual Quality Assurance Assessment) that an audit using the department of health guidance had not been carried out. Additional information provided verified that 3 out of 21 staff had received training about the prevention of infection and management of infection control. We saw a pressure relieving seat cushion that had torn plastic, which would prevent staff from being able to clean the cushion properly after use. This was drawn to the attention of the manager who immediately removed the cushion and discarded it in the rubbish. 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. We observed good infection control measures being followed when staff were dealing with soiled linen. Sluices were clean and fully operational. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good Caring staff are in sufficient numbers to ensure that peoples needs are well met. Recruitment practices at Halwill Manor have greatly improved and are protecting the people that live there. The home has a training and development culture that ensures competent and knowledgeable staff care for the people that live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined duty rosters for the weeks 13th-19th July, 20th-26th July and 27th2nd August 2007. Most days there were five or six staff on duty in the morning, four or five in the afternoon and through the evening. Additionally every day there was a cook and two domestics working eight till 2:30 p.m. However, on 18th and 19th July 2007 staffing levels were low due unexplained absences and sickness. The manager verified that the home does not use agency staff to cover such events because the team normally covers these. The manager felt that whilst it was not an ideal situation, people living in the home had not been put at risk on 18th and 19th July. Relatives felt that the provider asserts “good discipline” with the staff and they did not have any Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 22 concerns about staffing levels. We spoke to staff that told us that recent staff departures and changes to the recruitment procedures had an impact on staffing levels because newly appointed staff were not being allowed to start work until all the pre-employment checks had been completed. We explained to the staff that this was necessary to safeguard people living in the home. However, staff did not feel that people living in the home had been put at risk on the two shifts highlighted but felt that they had not been able to give people as much attention as they would have liked to. We asked people living in the home about the care they received, and we were told, “the care is very good” and “if you need help they’re there” There is a diverse staff team at Hal will Manor, with a gender mix that is consistent with the people living there. Requirements in respect of recruitment practices were followed up. The inspector examined the files. Of those, appropriate written references [two] had been obtained including criminal records bureau certificates and POVA checks. We established that the provider and manager had used 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 had implemented good practice in relation to recruitment procedures. We spoke to five staff all of whom verified that recruitment was taking longer because the provider and manager would not allow applicants to commence employment until all of the pre-employment checks had been completed. We spoke to staff about their experience and training opportunities in the home. 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. We spoke to qualified staff that felt well supported and kept informed of important developments by the manager and provider. Staff records examined demonstrated that three carers had completed NVQ level 2, two carers were doing NVQ level 2, one carer had completed NVQ level 3, one carer was doing level 3 and one carer was doing the assessor’s award. Five staff we spoke to verified that regular supervision and appraisals had been implemented. Recent supervision was recorded on all files examined. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 23 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 & 38 Quality in this outcome area is adequate The manager is qualified and has the necessary experience to run the home. They are aware of and work to the basic processes set out in the NMS. Quality assurance systems tend to be informal and it is evident that the views of people living and visiting the home are respected. 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. This was also illustrated by the AQAA which gave us limited detail about the areas where they still need to improve and achievement of this was briefly explained. Financial procedures safeguard people’s interests. On the whole health and safety issues are managed well. Equipment, such as wheelchairs and pressure relieving mattresses had not been maintained and were either missing parts or damaged and not fit for the purpose. People living in the home are, however, aware of safety arrangements and have confidence in the safe working practices of staff. This judgement has been made using available evidence including a visit to Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 24 this service. EVIDENCE: In the AQAA the provider verified that a survey would be carried out annually. However, information within the document was limited and we were unable to establish how this would be done. We spoke to the manager and provider about this who told us that this was still an area under development. The Cook told the inspector that waste was monitored and was seen seeking verbal feedback from people during lunch. People told us that meetings used to be held with them but none had been held recently. Records showing how money is managed on behalf of people 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 people’s money. A relative told us “they always send bills for whatever she’s had, always correct” 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 passed a Health and Safety course to NEBOSH standards. Certificates seen on files examined verified that some staff had attended infection control training. We saw a pressure relieving seat cushion that had torn plastic, which would prevent staff from being able to clean the cushion properly after use. This was drawn to the attention of the manager who immediately removed the cushion and discarded it in the rubbish. We were told that the manager is a qualified manual handling trainer and provides in house training regularly for staff. Sliding sheets and other manual handling equipment was seen being used by staff caring for people. We 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 fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home, relatives and staff told the inspector that the alarm was regularly checked. Certificated evidence verified that an engineer had checked the hoists, and two new hoists had been purchased as a result of recommendations made. First aid equipment was clearly labelled. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 25 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. Electrical appliance checks and risk assessments had been reviewed since the last inspection. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Equipment, such as walking aids, wheelchairs and a PEG feed machine was seen being used by staff that were caring for the individuals concerned. We observed people being transferred from chairs in the lounge into the dining room in wheelchairs. Several of the wheelchairs did not have footplates on, which when used by people could cause them injury. This issue was raised with staff and the manager and footplates were found and immediately fitted. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 26 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 x 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 27 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 OP18 Regulation 13(6) Requirement Vulnerable people must be protected by ensuring that everyone is clear that bullying behaviour is totally unacceptable. We asked the provider to deal with this immediately. Make arrangements to enable people living in the home to be fully involved in improving the quality of the service they receive by holding regular meetings with them and their representatives. Additionally, carry out surveys with them, their representatives and professionals visiting the home. Summarise findings and set these out into a report, so that people can see how and within what timescales steps will be taken to improve the service. We agreed to repeat this requirement and extend the timescale. Timescale for action 02/08/07 2. OP33 24(1,2) 31/01/08 Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 28 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 The nutritional needs of people living in the home should be known by being properly assessed with a tool such as the ‘Malnutrition Universal Screening Tool’ (available at www.bapen.org.uk). Care plans should be reviewed when people return for respite care to ensure that staff have the most up to date information about people. People living in the home should be confident that all of the staff that administer medication to them do this safely by following Halwill Manor’s policies and procedures. The recreational needs of people, particularly those with dementia or communication difficulties, should be assessed using a tool such as the ‘Pool Activity level instrument’. Activities should then be person centred and pitched at a level that is suitable for the individual. Ensure that other people in the home are not subjected to bullying behaviour, by carefully monitoring the situation and taking a proactive approach to stamping out such behaviour. Obtain a copy of the new safeguarding procedures from Devon County Council 6 OP26 Use the Department of Health guide ‘Essential Steps’ to assess current infection control management to protect people that live in the home and staff that work there. People living in the home should be confident that that all of the staff have received infection control training and as a result implement best practice. People living in the home should be confident that that all of the equipment used whilst caring for them is fit for the DS0000026717.V343138.R01.S.doc Version 5.2 Page 29 2 OP7 3. OP9 4. OP12 5. OP18 7. OP38 Halwill Manor Nursing Home purpose and in full working order. The manager should implement a system of auditting and regular maintenance of equipment such as wheelchairs, pressure relieving aids and bedsides. Halwill Manor Nursing Home DS0000026717.V343138.R01.S.doc Version 5.2 Page 30 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. 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