Inspection on 25/09/07 for Holcombe Hall Nursing Home

This inspection was carried out on 25th September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Holcombe Hall Nursing Home 23/03/10

Holcombe Hall Nursing Home 26/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holcombe Hall Nursing Home Holcombe Drive Holcombe Dawlish Devon EX7 0JW Lead Inspector Doug Endean Unannounced Key Inspection 25th September 2007 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holcombe Hall Nursing Home DS0000068534.V339383.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. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holcombe Hall Nursing Home Address Holcombe Drive Holcombe Dawlish Devon EX7 0JW 01626 862330 01626 888977 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) Holcombe Hall Nursing Home Ltd Mr William Stanley Warr Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (29) Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing only - Code N, to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - (Code DE (E)) Mental disorder, excluding learning disability or dementia – (Code MD (E)) The maximum number of service users who can be accommodated is 29. 26/02/07 22/03/07 2. Date of last inspection Brief Description of the Service: Holcombe Hall Nursing Home is a care home with nursing that is registered for 29 people of either gender. It can provide nursing care within the categories Mental Disorder or Dementia. The Registered Manager is a Registered Mental Nurse with many years experience in the National Health Service and the Independent Health Care Sector. As nursing is provided there a Registered Nurse on duty at all times. The home is situated between Teignmouth and Dawlish in an area called Holcombe. It has its own driveway and small parking area off a quiet residential road, Holcombe Drive, just off the A379. The House is situated in three acres of land, and has scenic views across Babbacombe Bay. The accommodation is provided on 2 floors that are accessed by stairs or a passenger lift. There are two levels off the second floor that have further bedrooms that the lift does not reach. People who live in the home, that are able can climb stairs, use these rooms. The home has a stair-walking device for those who are not able to manage stairs that have rooms on these levels. The communal accommodation is all on the ground floor and comprises of two lounges and a very large dining room, each with sea views. There is an accessible, private garden to the rear of the property with magnificent sea views also. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 5 The majority of bedrooms are shared and none have en-suite facilities although all have a wash hand basin. All rooms are within close proximity to adapted bathing/toilet facilities. The weekly fees for the home begin at £675 and are negotiated based upon the assessment of need that all of the people who live at the home have undertaken on them on an on going basis. Any up to date information about additional charges, such as hairdressing and chiropody, will be provided upon request. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on the 25th September 2007 beginning at 09:15 hours and lasted 6 hours. In that time we made a full tour of the home, interviewed three staff and four relatives. We also looked at the files of three people who live in the home and three staff files. The Registered Manager was appointed to the post, following the vetting process by the Commission for Social Care Inspection, in March 2007. In the process of planning the inspection questionnaires were provided to staff and relatives of people living at the home to complete. Eight staff returned forms and five relatives. The information from 7 other relatives questionnaires written in March 2007, shortly after the change of ownership and after the last inspection, were used to compare the views relatives now held about the home. The Registered Manager had produced an Annual Quality Assurance Assessment form that had additional information attached to show how the home is performing. Some of this information was check as training and maintenance files were sampled. What the service does well: What has improved since the last inspection? We have found that the record keeping arrangements for people who live in the home has improved with better evidence, through risk assessments and good care planning, as to what care is needed and how it is to be delivered. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 7 The recruitment process has improved and we found that the mandatory information that is required to be collected on all employees is now done so. Induction training has also improved using a professional package from an external provider that provides information about what is taught, and then signed off when this has been achieved. The environment has been improved, in particular the bathrooms that were poor at the time of the last inspection. They are now satisfactory but are to have further improvements in the future. There is also a full Health & Safety risk assessment done quarterly on the premises. 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. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standard 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home gathers sufficient information about people who might live at the home, before agreeing to admit them. EVIDENCE: We looked the files of three people who live at the home, and read how the home has recorded their passage of care since they were referred until the present time. Along side the information provided by health and social services professionals who may have been involved with a person being referred to the home the Registered Manager had completed a full pre-assessment sheet that gave personal details about the individual being assessed and went onto making a full assessment of their abilities covering twenty subjects such as mobility, sociability, speech and communication and how they sleep. From this a dependency score was achieved and this formed a baseline for all Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 10 subsequent care plans and reviews. There is also a second, more detailed assessment form, which provides more information about the way a new person is coping with their memory loss and how this affects activities of daily living such as continence and nutrition. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The method used to record the way care is to be provided and then actually provided, with outcomes, is clear. The medication practices, storage, administration and recording are good. EVIDENCE: The Registered Manager uses the information gained from referring agencies and the pre-admission assessment to draw up a care plan. We saw the care plans for three individuals who live at the home. The information was clear and easy to read and staff felt that they gave them good direction about delivering care to the people they care for. A risk assessment was found for each area of care that needed clarity such as nutrition, mobility, falls and tissue viability. Where bed rails had been indicated as necessary there was a completed risk Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 12 assessment held in a folder that also included the guidance information from several sources such as the Medicines & Healthcare products Regulations Agency. The method of recording how staff had managed care and the person’s response to it was also clear and covered many areas each day as a result of the format that is used. It was further enhanced by additional written notes where these were needed to describe an incident or the involvement of someone else such as the General Practitioner. In addition to these records the home employs an activities person every afternoon and she records the activity that she provides and who with in a diary. Due to the problems with memory it is unrealistic to expect that the people who live in the home would make an informed contribution to the review of care plans. The manager has therefore posted a note in the front lobby inviting relatives and friends to take part in the care planning process or make suggestions that would help at a review. We spoke to four visitors during the course of this inspection and received the comments from five others on the recently sent Commission for Social Care Inspection relatives survey forms. Seven further relatives survey forms were received shortly after the change of ownership early in 2007, and those comments read alongside the latest forms. There was a general view that the level of communication about the care provided and the person’s responses to it has been good. However, some individuals did feel that more formal arrangements for feedback would benefit them. The home maintains a professional relationship with the General Practitioner and Community Nurses who visit the home. Their services are obtained when needed so that the people who live in the home receive well-planed care as their needs change. The General Practitioner visits were recorded in the files that were read and were clear and concise. The home has a clinical room that houses the medication trolley, tethered to the wall when not in use. It also has several locked cupboards where dressings and prescription items were securely stored. There was clear advice on how staff are to monitor the use of creams using the advice given on suitable expiry dates. A drugs fridge was also in the room and a record made of the temperature. Regular medication is supplied in a monitored dose system. The medicine charts were looked at and provided proof of when the medication was received, how much, when it was administered and what returns were being made. The charts were accompanied by photographic identification of each of the people who receive medication. We also saw sample signatures of those involved in the administration of medication. During the inspection we saw that when people were being provided with any intimate care such as bathing or toileting they were with staff in rooms that had been provided with locks for privacy. People were also addressed using the name that they seemed to be comfortable with. Where bedrooms were shared there were privacy screens of some sort provided sometimes as part of the Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 13 room design. The homes quality assurance survey produced a 100 score for dignity, privacy and respect. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The homes performance was assessed against Standards 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The food provided to the people who live in the home is well prepared, of good quality and good nutritional value. People who live in the home are treated as individuals in a respectful way. The activities are focused providing mental and physical stimulation and therefore of good value to the people who live in the home. EVIDENCE: The Registered Manager obtains information about the likes and dislikes of the people who live at the home during the pre-admission assessment and the admission process. This information was seen in the records of three people who live in the home. It was also seen in the kitchen in respect of the food that individuals prefer to eat. The menu has been updated using guidance from the government website that has been developed to provide good information on Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 15 nutrition and diet following the report on eating habits in care homes. We saw the main meal being prepared and later eaten by the people who live in the home. It was well prepared, nicely presented using appropriate crockery, and in good portions. Those who needed assistance with eating were given it in a calm unhurried way. The cook has a record of each meal that is prepared each day. The Registered Manager and the cook told me that there is an emphasis on maintaining good fluid intake and that drinks are regularly offered to the people who live in the home. One relative we spoke to said, “The food was good and the staff were very good, and he felt there was love in the place”. The staff weigh each person resident in the home on a monthly basis and we saw the records that are made. Should a person begin to have problems with their food and fluid intake either due to agitation or a physical health problem the staff record weekly weights until the situation is resolved. The kitchen is a large room with distinctly marked areas for different tasks and where staff cannot enter if they are not suitably clothed. There is a food preparation area, a cooking area and a washing area making best use of a large space. The kitchen staff have been introduced to the “Safer Food, Better Business” documentation and the cook is waiting for a training date from the local Environmental Health Department. The cook and his deputy have worked in the home for several years sharing the responsibility for its smooth running. The staff were actively involved with the people who live at the home throughout the day. They helped with personal hygiene and dressing, toileting and also assisted individuals at meal times. They seemed to be well coordinated and to talk to the people guiding them through each task as it occurred. There is a multinational staff group who have come to the home with a variety of employment experiences many in the field of health care. They also have a varied degree of skills in spoken English. A small number of relatives made reference to this in the survey responses saying, “There is a language difficulty at times, and do not always understand what we say”. This is qualified with, “The carers seem charming and efficient”. Another wrote, “For most staff English is their second language, but communication seems good. The staff seem competent and well trained”. We did see staff taking time to make any communication with people clear and understandable. The home employs an Activities Person every afternoon of the working week. She works with individuals and also with groups. She adjusts the activity to the person so as to make the best use of their attention span and stimulate them to working on a task such as crosswords, puzzles and proverbs. The tasks provide mental stimulation and physical movement and dexterity. The Activity Person then records the activity and the person’s responses to it in the diary. As the information is valuable it would be best placed in the persons file perhaps on an activities record sheet. Other things on offer to the people who live in the home are musical entertainment monthly. The church choir also Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 16 come to the home to sing once a month. The people who live in the home also have access to the hairdresser who visits the home. We spoke to four relatives during the course of the inspection who were visiting people who live in the home. Each were complimentary about the care and attention their relative receives. Visiting times are open within reason. A number of people did make comment in the relatives survey forms that they would like, “Better facilities for visitors” and “There is no private place for visitors to visit/talk with relatives”. Relatives have also commented about the way the home allow people to express themselves and maintain their independence within limits. People are allowed to wander freely about the home, which is large and has a design to allow this to happen with minimal supervision but regular observation. Bedrooms are also personalised with various belongings such as photographs and some personal furniture. Holcombe Hall Nursing Home DS0000068534.V339383.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): The homes performance was assessed against Standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment process and training of staff has provided a safe place for vulnerable people to live. EVIDENCE: The home does have a complaints procedure displayed that people were aware of but have had no cause to use. Complaints have been investigated by the home during the past year and brought to a satisfactory conclusion following the procedure. The Registered Manager has a system for the recording of complaints that also states the outcome. The home has a robust procedure for the recruitment of staff. Three staff files were read and found to be complete with application forms, Criminal Records Bureau checks, references and checks on qualifications. There was also checks made on individual’s identification and work permits were on the files where these were needed. We looked at how the home was providing other protection for the people who live there. We found that the induction program covered the basic information on Safeguarding People. Staff had also attended training days provided by the Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 18 local authority by their safeguarding People team and there was evidence that more staff had been booked on this training. Holcombe Hall Nursing Home DS0000068534.V339383.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): The homes performance was assessed against Standards 19, 20, 21, 23 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides suitably designed and appointed accommodation for the people who live in it. The general refurbishment of the bathrooms is adequate. Some carpets are showing signs of age and are becoming unsuitable. EVIDENCE: Holcombe Hall is located in the area of Holcombe, which is between Teignmouth and Dawlish on the main coastal road. It is off a private unadopted road, Holcombe Drive, and has a curved driveway downwards to a Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 20 small parking area in front of the homes main entrance. Further parking is possible on Holcombe Drive in front of the home. The large detached property has two large lounges with high ceilings adjoining each other on the ground floor. There are a small number of stairs through two sets of French doors leading down to the paved patio area that has magnificent views through the grounds and over the sea. There is also a very large dining room with high ceilings on this level that has new dining tables and chairs in it. The windows are large and have shutters that do close over them. A wide corridor runs between the lounges and the dining room and there are several bedrooms off the corridor. The arrangement of the communal space will allow for activities to take place in one area without disturbing people in another area. The kitchen, office and clinical room are found beyond a key pad protected door at the end of the main corridor. There is also a bathroom with a wet room that has received some upgrading since the last inspection. There is a wide staircase leading to the first floor that has a locked stair guard at the bottom. The home also has a shaft lift that takes people up to the first floor where more bedrooms, singles and double’s can be found. From this level the large bedrooms have views again mostly out to sea. Two mezzanine levels provide further accommodation and bathrooms for the people who live in the home. The bath on the mid level has its own built in hydraulic hoist. The bedrooms have a nurse call system that is activated by pressure pads where this is assessed as necessary. All the radiators have guards on them. There are two further bathrooms that have had some re-furbishing to improve their appearance. This had been an issue at the last inspection and has been adequately attended to. We saw a cracked pane of glass in one bedroom that needed attention. There is level outdoor space to the side and rear of the building that has wide brick paved paths surrounding flowerbeds or overlooking the grounds down to the sea. The area looked attractive and well tended. The furniture both in the communal space and in the bedrooms was appropriate for the people who live in the home. The seating offered support and reasonable seat height and beds varied in style to meet the needs of the person using them. The carpets on the first floor were beginning to suffer from regular cleaning with joins opening up but not yet causing a trip hazard. This was discussed with the Registered Manager. We made a tour of the whole home and found it to be clean and free from unpleasant odours. The cleaners now have more understanding of the issues relating to substances that they use and there safe storage. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 21 The laundry is located outside of the home. It has one washing machine with a sluicing cycle and a commercial dryer. This facility is staffed to operate twelve hours a day. The Provider has submitted plans to fully refurbish the home whilst extending to the side and rear. The home also employs its own maintenance man who is also shared with another home in the group but spends most of his working days at Holcombe Hall. The issue of infection control has been further improved with the purchase of Sangenic waste bins for the effective storage and disposal of incontinence pads. Also blue aprons and gloves are at the entrance of the kitchen. Staff were seen to put them on before entering the kitchen and they also kept to the area marked out for them. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 22 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): The homes performance was assessed against Standards 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sufficient numbers of staff adequately prepared for the work they do. The recruitment process is satisfactory. EVIDENCE: We spoke to the Registered Manager about the recruitment process for new staff. He provided evidence in a sample of three staff files that showed that the home follows all the appropriate checks to establish the fitness of a person before they are employed to work in the home. The files had completed application forms, evidence that a POVA first and Criminal Records Bureau had been done, references and proof of identification and qualifications. The staff that had been recruited from overseas held work permits where these were needed. We also saw proof of contracts of employment for the staff employed at the home. The Registered Manager has found local recruitment of staff to be a continual challenge. However the standard and skills of the overseas staff that are employed are high. employed that are Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 23 The staff surveys that were returned have raised issues such as problems of communication between the people who live in the home and some overseas staff. The manager is aware of this and encourages improvement in this area with some staff attending lessons to improve spoken English. Other comments were about the different management style between the previous manager and the present one who is reported to have been more “hands on”. We can only state that the overall performance of the home has improved since the last inspection under the present Registered Manager. One carer stated “The new manager seems to try his very best to keep his management style open and honest. He makes us feel that everyone has an important role in keeping the home running well”. Finally there are comments about pay and holidays that are not the responsibility of the Commission for Social Care Inspection. This home provides nursing care to older people who suffer from a mental health problem or dementia. It has at least one registered nurse in the home over the 24-hour day who is supported by care staff who have received suitable training to prepare them for their role. The rotas we saw showed how the staffing levels shift by shift. We saw that the home uses a structured induction and foundation training program from an external provider. We saw the documentation used to record the training given at induction, and that the Registered Manager had made entries when a subject had been taught or discussed and the recipient was competent. There has also been a significant amount of mandatory training received and other training planned for the future such as Person Centred Care for people with Dementia. The Registered Manager provided information about this as supporting evidence to the Annual Quality Assurance Assessment. We spoke to two care staff and the cook. One member of the care staff has only recently joined the home and was able to comment that the induction program that she had just completed had prepared her well for the role she has in the home. We saw the completed record and also information about the other training she has received. The Registered Nurse we spoke to has worked at the home for two years following her adaptation training. She seemed confident in her duties and had good language skills. Her training record showed that she has had specific training in the subject of dementia care. The other staff member is on the ancillary staff and has worked at the home for several years. She enjoys her work and had good knowledge of the role she plays in the home. There are seven members of the care staff who have a National Vocational Qualification in care at level 2 or above. This at present does not achieve the 50 level required by the National Minimum Standards. However, the home does employ several staff from overseas who hold a professional nurse qualification in their own country but are working as Senior Carers in this home. The Work Permits authority do have a statement that people who fall into this category are deemed to be qualified to the equivalent of National Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 24 Vocational Qualification level 3. This would take the proportion of National Vocational Qualification or equivalent to beyond 50 . Apart from sufficient numbers of care staff the home employs suitable numbers of staff for domestic, catering and maintenance duties. One relative did comment in the returned survey form that the staff change every week. The records however show that there have been only five staff leave the home, and be replaced, since the last inspection in February 2007. The same person stated that the person in charge changes every week. The present Registered Manager took up post, initially as the Deputy Manager in late 2006 then as Registered Manager in March 2007 when the previous manager/provider left the home. There have been therefore only two Registered Managers in the home since it was first registered. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 25 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): The homes performance was assessed against Standards 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed effectively by an experienced nurse to the benefit of the people who live and work in the home. The welfare of the people who live in the home has been made its priority with good improvements to the staff training and recruitment, and the maintenance of the premises. EVIDENCE: The home changed ownership early in 2007 and the new Registered Manager completed the process of this registration in late March 2007. He is a Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 26 Registered Mental Nurse with over 30 years experience and has a Diploma in Management Studies (Plymouth University). He came to the home with a good deal of experience of managing homes of this type in the independent health care sector since 1994. In the short time that he has been at the home in this position he has addressed the points that were raised at the last inspection as recorded in the text of this report. Many of the issues have been resolved whilst others have received attention and are part of ongoing work as stated in the Annual Quality Assurance Assessment he completed for this inspection. During this inspection he was seen to command the respect of the staff that work in the home and the relatives that we spoke too. Such issues as the staff recruitment procedure and mandatory staff have been brought up to the standard and additional training planned. There has also been improved documentation both relating to the people who live in the home and also to the premises, which has also been improved. We saw risk assessments for falls and also for the use of bed rails that are reviewed monthly. He has produced a room-by-room risk assessment of the premises guided by a professionally prepared assessment from the Forum of Private Businesses called, “Putting Safety First”. The home has the use of the internet and are linked to a national website for the sharing of information about nursing people with dementia and mental health problems via a university in England. The Registered Manager has commenced some quality assurance exercises that include obtaining the views of the advocates for the people who live in the home and cannot make their own views known. There were responses shown to us along with those from General Practitioners and nurses who come to the home. The responses gave a 100 rating for dignity, privacy and respect. The Manager plans to update the information annual. There is also a quality assurance audit monthly of the accident record book that is their to identify trends. The home does not manage the financial affairs of people who live in the home. These are managed by relatives, appointed persons, solicitors or the Court of Protection. Records were seen where small amounts of pocket money has been held and used on behalf of individuals who live at the home. The improvements in staff recruitment, training and the management of the building and its maintenance, have been good since the last inspection. The staff group are better prepared for the work they do and this has resulted in the positive comments from the relatives we spoke to and those who completed the survey forms. The investment in maintenance of the building has been sufficient to make it adequate and suitable for its purpose. The assessments of the building have identified ongoing work and this inspection has helped to priorities a small number of issues. We sampled the maintenance information that was provided in the Annual Quality Assurance Assessment form and found it to be satisfactory. Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 27 Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 28 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 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 X 3 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 16(2)(c) Timescale for action The Registered Person shall 01/11/07 provide in rooms occupied by service users adequate floor coverings. This is to prevent unnecessary falls due to poorly fitted carpets. Some carpets are beginning to part at joins. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP12 OP13 OP7 OP19 Good Practice Recommendations It would be good practice to make the notes about how a person has responded to an activity in their file. Consideration should be to allow people to visit their relatives in private. When bi-annual reviews of care plans are taking place advocates should be informed to allow them to attend if they wish. General Health & Safety inspection of the building should be repeated. A pane of glass in a bedroom was cracked and will need replacement. DS0000068534.V339383.R01.S.doc Version 5.2 Page 30 Holcombe Hall Nursing Home Holcombe Hall Nursing Home DS0000068534.V339383.R01.S.doc Version 5.2 Page 31 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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