CARE HOMES FOR OLDER PEOPLE
Holcombe Hall Nursing Home Holcombe Hall Nursing Home Holcombe Drive Holcombe Dawlish Devon EX7 0JW Lead Inspector
Andrea East Unannounced Inspection 10:00 26th February 2007 and 22 March 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 Holcombe Hall Nursing Home DS0000068534.V325100.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.V325100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Holcombe Hall Nursing Home Address Holcombe Hall Nursing Home 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 Mrs Norma Robinson 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.V325100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28/07/05 Brief Description of the Service: Holcombe Hall is a care home registered for 29 Service Users of either gender who require nursing care within the categories of Old Age, Mental Disorder or Dementia. There is a registered nurse on duty at all times. The home is situated in Dawlish, within a quiet residential drive just off the A379. The House is situated within three acres, and has scenic views across Babbacombe Bay. The accommodation is provided on 2 floors and can be accessed by stairs or passenger lift. There are several levels on the second floor to which the lift does not reach. Service Users who are capable of climbing stairs use these rooms and the home had a stair device for those who were not. Communal accommodation comprises: Two lounges and a large dining room on the ground floor, each with sea views. There is an accessible, private garden to the rear of the property. The majority of bedrooms are shared. None have ensuite facilities, all have wash hand basin. All rooms are within close proximity to adapted bathing/toilet facilities. The range of weekly fees for the home ranged from £479.00 to £ 650. The information about additional charges was provided as part of the homes inspection site visit on 26/02/07. The homes service users guide was not available at the inspection visit. Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out over two days with the acting manager. The acting manager will replace the registered manager on her retirement, which was planned for the near future. The registered manager was the previous owner of the home. This was the first inspection since the recent purchase of the home the new owner of the home was not present at the inspection. The inspector toured the premises, spoke to members of staff service users and their relatives and examined a range of documentation. What the service does well: What has improved since the last inspection?
This is the first inspection since the current owners purchased the home. Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 6 What they could do better:
Assessment records should include information, completed with discussion with the potential service user and/or the service users representative such as a care manager or a relative. This will ensure that care staff will have the right information to meet individual service users needs right from the start of the service. The new assessment forms, including nutritional assessment forms, manual handling and risk assessments should be introduced as planned. The information obtained on the forms will give care staff the information they need to care for service users safely and will help to monitor the changing needs of the service user. The service users care plans should be extended to include information about service users mental health and social needs. There should be evidence of how service users or their advocates had been involved in the service users care plan. The reviews of service users care plans should be consistently well completed in that reviews must include changes in medication, incidents and accidents. Good care planning gives all staff the information they need to meet service users needs. The storage, recording and administration of medicines must be improved. The recording system for administration of medicines must be well completed, with staff dating signing and making clear why any entries have been changed. The practice of routinely crushing medication and putting medicines into service users drinks or food if service users refused medication must be reassessed, recorded in the service users care plan and discussed with an outside advocate or health professional. This puts service users at risk of being given medication they have not consented to, there is a high risk of cross contamination from the container tablets are crushed in which may have physical side affects causing harm. Creams must not be used unless they have been prescribed and the reasons for their use must be detailed in service users care plans. This puts service users at risk of being given medication they have not consented to, there is a high risk of contamination from the cream, for example if the service user was allergic to it, which may have physical side affects causing harm. Communal “homely remedies” such as a large bottle of ‘Simple Linctus’ (a cough mixture) must not be used for all service users. All medicines must be used for individualised named service users and the dosage and type of medication must be recorded. Staff said that this was used for all service users, rather than an individual named service user and had been a practice in the home for years. This puts service users at risk of being given medication they have not consented to, there is a high risk of contamination from the
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 7 mixture, for example if the service user was allergic to it, which may have physical side affects causing harm Policies and procedures on safe medication administration must be made available to all staff. This will give care staff the knowledge and skills to administer medication safely as poor medication administration places services users at risk. The practice of serving food and drink in plastic cups saucers and bowls for most service users, must be re-assessed. The reasons for using plastic crockery must be detailed in individualised service users care plans and thought must be given to the wishes of the individual service user. The practice of using plastic cups and saucers for all service users without individualised assessment, takes away service users choice. The homes accident book showed sixteen accidents from 01/01/07 to 12/02/07 and there was evidence of poor practice and poor care in the past that had not been fully investigated. The service must ensure that adult protection guidance is followed. They must inform the Commission of any incident that affects the well being of staff and service users. They must provide evidence of the investigations taking place into the behaviour of staff and the disciplinary action taken. Staff must receive training and guidance on safeguarding adults/adult protection issues. Improvement in these areas will safeguard service users from those staff who are unsuitable to work with vulnerable people. Training would give staff the skills and knowledge they need to protect service users from abuse. The service must ensure that there are systems in place to so that the home is clean and tidy and that creams and liquids are stored safely. This would protect service users from risks of cross infection and health and safety risks as if swallowed these liquids could be potentially fatal. Risk assessments for the premises must be completed and a system introduced to ensure that action is taken to address identified risks. This will enable the homes staff to identify, monitor and take action to minimise risks to service users, protecting them from harm. Staff must receive training in infection control and first aid. At least fifty per cent of staff should be trained to National Vocational Qualification at level 2 or above in care. Staff new to the home must receive an induction into the home. Training would give staff the skills and knowledge they need to protect service users from harm through poor practice and to meet service users individualised needs. Recruitment procedures and practices must be improved so that Staff will not be employed in the home until all relevant employment checks, including application forms, police checks and references have been received. This will
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 8 safeguard service users from those staff who are unsuitable to work with vulnerable people. The service must develop and implement a quality assurance system. This will enable the homes staff to identify, monitor and take action to improve policies procedures and practices to improve the services to service users. 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.V325100.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 Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users did not move into the home without having his or her needs assessed and being assured that these needs would be met. The home did not provide intermediate care EVIDENCE: Two residents files were examined and discussed with the acting manager of the home and the care staff on duty that day. This included discussion about how the home obtained information prior to service users coming into the home and how the home assess and inform potential residents. The files examined showed some assessment documentation including some information about service users social history such as past and present likes, dislikes, hobbies and interests. Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 11 Assessment information also included some initial information, which staff confirmed was completed with discussion with the potential service user, the service users representative such as a care manager or a relative. These discussions were not recorded in the service users file. It is important to record this information so that all staff are made fully aware of the needs of the service user right from the start of the service. Assessment documents did not detail potential risks including risks from falls and manual handling. For example one file said that the service user needed to sit in a chair with arms, to prevent falling out of the chair, although mentioned in initial documents this had not been built into assessment and care plan documents. The service user had then suffered an injury after falling from a chair with no arms. The acting manager showed the inspector new assessment forms that included nutritional assessment, manual handling and risk assessments. The acting manager confirmed that they were in the process of introducing these for all service users. Well-completed assessments are important as they provide staff with the information they need to meet residents needs right from the start of the service, when they first enter the home. A relative of a service user who had recently moved into the home, said that he had been provided with information about the services and facilities the home provided. He also said that the welcome and the information she had received helped him to feel reassured that his relative would be well cared for in the home. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users, personal and social care needs were not fully met and were not clearly recorded in the individual service users plan of care. Service users were not protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Service users care needs were not fully met, as care staff did not have the information they needed to inform them of service users needs. The care plans examined gave minimal information about service users mental health and social needs. For example on service user had a history of being aggressive and the way staff approached the service user was not made clear so that staff were not always aware of the best way to approach him, this then led to aggressive incidents. There was very little evidence of how service users or their advocates had been involved in the service users care plan.
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 13 The reviews of service users care plans was not consistently well completed in that reviews did not always include changes in medication, incidents and accidents. Assessment documentation about personal care and health needs was also limited, as it was a tick box system indicating that tasks had been completed rather than how service users had been supported in meeting their needs. This information was not easily transferable into a care plan that care staff could relate to the care needs of the service users. The assessment documentation did indicate that service users physical needs were met. The acting manager described plans for the future to introduce changes in the format for assessment and care plans. These changes would include more detailed assessment and care plan formats so that staff would be able to have up to date information on the full range of care needs for service users. The acting manager also described changing the way care plans are reviewed. Improved assessment and care planning would give care staff the information needed to meet service users needs. On the first site visit to the home on 26/02/07 medication administration in the home placed service users at risk. The inspector examined the recording system for administration of medicines and this was poorly completed. Entries had been scribbled out and changed with no date, no signature of the member of staff and no indication of why the entry had been changed. Staff confirmed that they were routinely crushing medication and putting medicines into service users drinks or food if service users refused medication. This had not been recorded in the service users care plan or discussed with an outside advocate or health professional. This puts service users at risk of being given medication they have not consented to, there is a high risk of cross contamination from the container tablets are crushed in which may have physical side affects causing harm. A high number of service users were being treated by staff with a cream that had not been prescribed and the reasons for it’s use was not detailed in service users care plans. This puts service users at risk of being given medication they have not consented to, there is a high risk of contamination from the cream, for example if the service user was allergic to it, which may have physical side affects causing harm. A large bottle of ‘Simple Linctus’ (a cough mixture) marked “Holcombe Hall” was stored on the medication trolley, as a communal bottle. Staff confirmed that this was used for all service users, rather than an individual named service user and had been a practice in the home for years. This puts service users at risk of being given medication they have not consented to, there is a
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 14 high risk of contamination from the mixture, for example if the service user was allergic to it, which may have physical side affects causing harm Policies and procedures on medication administration were stored in the homes office. There was no evidence that staff had seen and understood these documents. Poor medication administration places services users at risk. On the second site visit to the home on the 22/03/07 the acting manager had taken steps to start to improve the medication administration system. He had moved the location of a fridge used for storing medicines, improved the recording of medications administered and asked staff to review the storage of medicines. The use of the cough mixture and crushing medicines was not re examined on the 22/03/07 but will feature at the next inspection of the home. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users maintained contact with family and friends in the home and local community and the lifestyle in the home satisfied their social, cultural and recreational needs. Service users received a balanced diet in pleasant surroundings at times that suited them. EVIDENCE: Most of the service users in the home have some kind of mental health frailty which makes communication, including expressing choices difficult for them. Service users files and ongoing records in the home did not always show how the home takes into account service users preferences and choices, as discussed and agreed with the service user or their advocate. Written accounts of how service users prefer to be cared for, help staff to plan and provide consistent care with the service user. Despite this lack of written information the inspector noted that some staff did try to offer the service users a choice of where they sat, what they had to eat and where they wanted to be in the home. For example one service user
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 16 although unable to express themselves, walked in and out of the dining room, was offered the opportunity to sit down or carry on walking alone or with a member of staff. Staff were also observed offering a choice of sandwiches and drinks to service users and for those service users unable to communicate staff were aware of their likes and dislikes. When asked staff said that they knew what service user liked to eat because there families had suggested meal options. A relative visiting the home said that he was always welcomed in the home by the staff and that the home had supported him in visiting over meal times so that he could carry on, sharing a meal with the service user, something the service user had always enjoyed. The inspector noted that the kitchen was clean and tidy. A member of the catering staff, was preparing meals and she confirmed that service users were offered a choice of meals, snacks and drinks. The acting manager said that five staff had recently undergone training in Basic Food Hygiene and confirmation of this was held on staff files. The inspector noted that food and drink was served in plastic cups saucers and bowls for most service users. Staff said that this was due to some service users being at risk of injury if they had ceramic plates and cups, which could be broken, become sharp and injure them. The reasons for using plastic crockery was not detailed in individualised service users care plans and no thought had been given to the wishes of the individual service user. Some service users could have safely managed ceramic plates and cups but had not been given the choice. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Complaints were not always listened too, taken seriously and acted upon. Service users were not protected from abuse. EVIDENCE: The Commission had received an anonymous complaint, which was the main focus of the first day of the inspection/site visit. The complaint centred around the observation that several service users appeared to have unexplained bruising. The acting manager confirmed that there had been concerns at the number of bruises some service users had. To address this a notice had been displayed in the home reminding staff of the need to use manual handling equipment and use appropriate moving techniques when assisting service users to move. Manual Handling plans in service users individual files were not consistently well completed, so that staff did not always have the information the needed to move service users safely. The homes accident book showed sixteen accidents from 01/01/07 to 12/02/07. The acting manager confirmed that this had been recognised as a high number of accidents and that this seemed to be related to the time when staff were handing over from the morning shift to the afternoon shift. A memo
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 18 had been displayed informing staff to remain in communal areas to ensure that service user were not left unattended. While examining staff files the inspector noted that on three occasions in the past, one member of staff had been reported to the manager for behaving in a way to put service users at risk. The manager had not followed adult protection guidance, had not informed the Commission, there was no evidence of an investigation taking place into the behaviour and had not taken disciplinary action at the first incident. This placed service users at continued potential risk from this member of staff. After the third occasion the member of staff left the home and was no longer employed at the home, at the date of the site visit. The acting manager provided the Commission with the relevant information to proceed with consultation in this matter with the local authority Adult Protection team. There was little evidence that all staff had received training or guidance on safeguarding adults/adult protection issues. This lack of awareness places service users at risk, as staff may be unaware of what is poor practice and how to report poor practice. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service Users did not live in a safe, comfortable home. Service users rooms were comfortable and furnished with personal possessions. The home was not clean and hygienic. EVIDENCE: On the first site visit to the home the inspector noted that Bathrooms and toilets were very dirty. Tiles on the Bathroom/ shower areas were poorly fitted broken and falling off. Soiled clothing, bags and creams were left in one of the homes bathrooms. There was no evidence of staff separating soiled dirty linen from service users clothing/laundry. Used incontinence pads had been left in one of the homes bathrooms. Also left unattended in one of the homes bathrooms were large containers of shared shampoo, cleaning fluids and creams open and unlabelled.
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 20 The inspector noted that wheelchairs and commodes in service users rooms were also very dirty. The lack of cleanliness and poor storage of creams and liquids placed service users at risk from cross infection. In addition liquids posed a health and safety risk as if swallowed could be potentially fatal. The inspector noted that door wedges were being used to prop open fire doors. In the event of a fire this placed staff and service users at risk as fire door would not automatically close. The home was issued with an immediate requirement to remove door wedges, make an assessment of fire risks and if necessary fit opening devices as approved by the Fire Authority. The acting manager confirmed that action had been taken to address this within the agreed timescale of twenty- four hours. On the second visit to the home the acting manager had instructed staff to clean the premises. Bathrooms and toilets were much cleaner, liquids and creams had been removed, commodes had been replaced or cleaned. There was a marked improvement in the appearance of the bathrooms and toilets. There was no evidence of how this improvement would be sustained, as the home did not have a quality assurance system. The overall appearance of the home is “tired” in that rooms need repainting or redecorating, carpeting needs to be replaced, some chairs are worn and dated. The acting manager said that the new owner had plans to refurbish and redecorate the home. Risk assessments for the premises were not available for inspection. The acting manager had obtained a new format for recording risks in the environment and he confirmed that this would be completed in the future. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service users needs were not always fully met as some of the staff were not trained and competent to do their jobs. Service users were not protected by the homes recruitment practices. EVIDENCE: Staff files showed that some staff had been trained in some areas such as, manual handling and health and safety. However the training was not consistent across all staff, and some training had been completed in 2005 and not updated. There was no evidence of staff training in infection control or first aid. There was no evidence of NVQ training for staff. There was no evidence of a induction training into the home for new staff. Training for staff is important as it gives staff the knowledge and skills to care for service users well. There was no evidence of a induction training into the home for new staff. The manager did not have an ongoing record of staff training. An ongoing staff record would assist the manager in quickly identifying when staff needed training updates. Staff files examined did not always include application forms, police checks and references. Twelve staff, some who had been employed at the home for
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 22 many months had not had police checks or protection of vulnerable adults checks. This places service users at risk as service users are being cared for by people not suitable to work with vulnerable adults. The acting manager had recognised the importance of these checks and nine forms had been sent off. An immediate requirement was made to ensure that staff who were not in the process of applying for police checks were not employed in the home. The acting manager responded immediately to take action to address this and confirmed in writing within twenty- four hours of the action the home had taken. The acting manager had plans to introduce a new system of recruitment that would capture all the relevant information needed to ensure that staff are suitable to work in a caring environment. Holcombe Hall Nursing Home DS0000068534.V325100.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home, which is run and managed by persons who were fit to be in charge. The current management and leadership arrangements were not in the best interests of service users. Service users financial interests were protected. The health, safety and welfare of service users was not always promoted or protected EVIDENCE: At the time of the inspection visits the current registered manager for the home had been on leave. The current registered manager was the previous owner of the home and had agreed to remain with the home until the acting
Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 24 manager was registered with the Commission. This had resulted in a period of time when members of staff were not clear who to go to for support and guidance. It also meant that the acting managers plans for the development and future for the home could not be fully implemented. This had resulted in Management issues that affected the well being of service users not being addressed for example health and safety risk assessments not being completed and poor recruitment practices. (see environment section and as detailed throughout the report). The acting manager had completed the process for registration and on the 15th March the current registered manager formally notified the Commission of their intention to resign as the registered manager. The acting manager was unable to comment on the arrangements in place to protect service users financial interests, as he did not have access to these records. There were no records available showing how the home safeguards service users financial interests. There was no evidence of a quality assurance system being used in the home to monitor and improve practice and services for service users. Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 25 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 1 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 1 x x 2 Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement Extend service users care plans to include service users mental health, social needs and how service users or their advocates had been involved in the service users care plan. Timescale for action 29/06/07 2 OP9 13 The registered person shall make 29/06/07 arrangements for the recording, handling safekeeping, safe administration and disposal of medicines received into the home Medication records must be, consistently, well completed, Staff must sign and note, when medication has not been dispensed. Medication must be administration, stored and managed in line with good practice guidance. Ensure that complaints are recorded showing the investigation that took place and the outcome of the investigation. Ensure that all staff receive training in the safeguarding of adults/adult protection issues
DS0000068534.V325100.R01.S.doc 3 OP16 22 29/06/07 4 OP18 19,18 29/06/07 Holcombe Hall Nursing Home Version 5.2 Page 27 5 OP18 37 6 OP19 13 7 8 9 OP19 OP19 OP26 13 13 16 10 11 OP29 OP30 19 18 12 13 OP30 OP30 18 18 Implement a system that ensures any adult protection issues/safeguarding adults issues are report to the Commission Ensure that there is a system of monitoring and taking action to address concerns, highlighted in accident recording. Risk assessments for the premises must be available for inspection Ensure that cleaning fluids are kept securely. Ensure that there are cleaning schedules in place in the home so that all parts of the home are clean and hygienic Ensure that all staff employed in the home have police and reference checks in place. Provide evidence of staff receiving up to date training in infection control, first aid, moving and handling and health and safety. Provide evidence that 50 of care staff have received National Vocational Qualification training. Provide evidence that staff new to the home have undergone induction training to a recognised national standard 29/06/07 29/06/07 29/06/07 29/06/07 29/06/07 29/06/07 29/06/07 29/06/07 29/06/07 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 OP3 Good Practice Recommendations As planned extended assessment documentation, so that information, completed with discussion with the potential service user, the service users representative such as a care manager or a relative, are recorded.
DS0000068534.V325100.R01.S.doc Version 5.2 Page 28 Holcombe Hall Nursing Home 2 OP7 As planned, implement new assessment forms, that inform service users care plans and that will include nutritional assessment, manual handling and risk assessments. Extend Service users files and ongoing records in the home to show how the home takes into account service users preferences and choices, as discussed and agreed with the service user or their advocate Reconsider the use of plastic cups, saucers and bowls for service users. Record the reasons for using plastic crockery in individualised service users care plans and ensure that service users are given the choice of what crockery they would like to use. As planned improve the overall appearance of the home, by the refurbishment and redecoration of communal and private rooms. Implement as planned the introduction of a quality assurance system. 3 OP14 4 OP14 5 6 OP26 OP38 Holcombe Hall Nursing Home DS0000068534.V325100.R01.S.doc Version 5.2 Page 29 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
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