CARE HOMES FOR OLDER PEOPLE
Hollow Oak Nursing Home Haverthwaite Ulverston Cumbria LA12 8AD Lead Inspector
Marian Whittam Unannounced Inspection 31st January 2006 1:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hollow Oak Nursing Home Address Haverthwaite Ulverston Cumbria LA12 8AD 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) 015395 31246 015395 30202 Hollow Oak Nursing Home Limited Mrs Angela Peachey King Care Home 27 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (27) of places Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 27 service users to include: - up to 27 service users in the category of OP (Old age, not falling within any other category) - up to 4 service users in the category of DE(E) (Dementia over 65 years of age) Date of last inspection 9th June 2005 Brief Description of the Service: Hollow Oak is a care home providing nursing care for 27 older people, four of whom may have dementia. Hollow Oak is well established and the current owner has been in charge for the last twenty-three years. The home is in the village of Haverthwaite, close to the market town of Ulverston and has good road access via the A590. The home is in a period house over three floors, which has been adapted to its current use and residents live on two of the floors. The floors used by service users have a passenger lift but two bedrooms are reached by a short flight of stairs. The bedrooms in the home vary in size and layout and are individually decorated in keeping with the homes period style and they retain many original features. The home has a large entrance foyer that is also used as a lounge and seating area, there is another lounge and a lounge/dining area and a small conservatory for service users. Outside there are large gardens to the side and rear of the home and these are well maintained and accessible to all service users, with seating for residents. There is a car park to the front of the building for visitors and staff. There are good views over the gardens and surrounding countryside from the communal rooms and some of the bedrooms. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 31st January 2006 and lasted 5 hours. Time was spent looking around the home, speaking with residents individually in their rooms and in groups and also speaking with visiting relatives, with staff and the owner. The inspector looked at records to do with the day-to-day running of the home, medication and the care of residents and all parts of the home were inspected. What the service does well: What has improved since the last inspection?
Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 6 The home has improved and carries out a more in-depth assessment prior to admission, to ensure the correct level of care can be provided. This assessment process is being continued throughout the first month after admission to give a picture of the resident’s needs. There is a much clearer and more consistent care planning system in place now to provide staff with the information required to satisfactorily meet residents’ needs that the manager is continuing to develop and improve. The owner has been continuing to improve resident’s bedrooms with 4 having been redecorated, more nursing beds provided for residents and 4 rooms re carpeted. The home has bought a new mini van with a lift for wheelchair use to improve resident’s transport and opportunities for trips out and for appointments. What they could do better:
The provider confirmed staff have CRB and POVA checks before starting work in the home. However the home must be able to provide evidence of this and keep records in the home that checks have been done to safeguard resident’s welfare. Also periodic checks of nursing staff registration status with the NMC should be done to ensure there had been no changes since recruitment. A member of staff is responsible for fire training in the home but there were no records kept of the training dates in the home. The home should make sure it keeps all records required by regulations available for inspection in the home. Following changes to the arrangements that affect the disposal of medicines in care homes (nursing) community pharmacists cannot accept medication waste from care homes (nursing) unless their pharmacy holds a Waste Management Licence. The provider must be able to show that arrangements are in place to safely dispose of medication and through a licensed waste disposal company and must retain records of theses transactions. The home needs to make sure that it records medication quantities where they are prescribed as variable. To promote good practice staff should check and record pulse rates prior to digoxin administration and making sure they have a system to safely identify residents during medication administration. To promote continued good practice in the home staff should be given training on current adult protection procedures and abuse. . Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 7 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. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 and 5 The standard of the pre admission assessments done by the home is sufficiently detailed to ensure individual needs could be met on admission. EVIDENCE: The home has an admission process that includes an assessment of need and a four to six week month’s trial period, during which time the assessment is continued. The home should make sure that all assessments are signed and dated by the person doing the assessment. Information is gathered from other agencies and where appropriate a social services management plan. All prospective residents and their families are invited and encouraged to visit the home prior to admission. This gives them an opportunity to assess the quality and suitability of the home. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 The care planning system is now more consistent to provide staff with the information they need to meet residents assessed needs. Some aspects of medication practice are not satisfactory to ensure resident welfare and good practice. Personal support is being offered in the home in such a way as to promote resident’s individual dignity, privacy and choice. EVIDENCE: All residents had a plan of care and personal and clinical risk assessments in place that have been reviewed. These have been developed and improved to make them clearer and core consistent. Clinical guidance was in place for specific nursing needs. There is evidence that residents are involved in making choices about their care. Residents confirmed that their opinions are sought about their care and life in the home generally. Residents said they felt their privacy and dignity was respected and promoted. Resident’s health care needs were being attended to and there is evidence of multi disciplinary working with other agencies and health professionals to meet healthcare needs.
Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 11 Medication needs some improvements for resident safety and good practice. The home should always remove out of date or no longer required medication promptly, record the pulse rate taken before administration of residents receiving digoxin and should implement a system of identification of residents for medicines administration. The home is not stating the dosage of tablets given when there is a choice of dosage for variable doses and as required medicines and must do this. The home keeps records of medicines it receives and returns to the pharmacist. However following changes to the arrangements that affect the disposal of medicines in care homes (nursing) community pharmacists cannot accept medication waste from care homes (nursing) unless their pharmacy holds a Waste Management Licence. The home must be sure it is safely disposing of medicines clinical waste safely and show that they have arrangements in place for the collection of waste medication with a licensed waste disposal company and are keeping records of all transactions. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The meals in this home are of a high standard offering both choice and a good variety and catering for resident’s preferences ands special dietary needs. EVIDENCE: Several of those spoken with thought the quality of the food provided was “excellent”, some others thought it was “ very good”. Residents said that the cook came and asked them about what they wanted to eat and if they did not want what was on the main menu they could have something else, one resident said “ I have only to say and they will try to get it for me”. All spoken with agreed there is a choice of food each day and that there is plenty to eat and drink and that they enjoyed their meals. The menus and records of food served showed a varied and nutritious diet that catered for special dietary needs. Residents commented on the home baking and the afternoon tea and the “fantastic buffets” put on over Christmas and the food at the Christmas party and festivities during the year. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory complaints system with some evidence that residents feel that their views and concerns are listened to and acted upon. Procedures are in place to protect residents from abuse but up to date staff training needs to be provided on this. EVIDENCE: The home has a complaints procedure and records formal complaints for investigation. Residents and relatives spoken to were confident that the manager and owner would deal with any complaints they made. There have not been any complaints made to the home or CSCI about the service since the last inspection. There are procedures in place to protect vulnerable adults, on handling aggression towards staff and for whistle blowing including multi agency guidance and these were available for staff in the home. There was no evidence that staff had received any up to date training on adult protection and abuse. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23 and 26 The environment in the home is, clean, warm and homely with a good standard of decoration, regular maintenance and refurbishment to give residents a comfortable home. EVIDENCE: The home is well maintained with regular, planned maintenance and a good standard of décor throughout that provides a clean, tidy and homely environment for residents. The lounge and dining areas are comfortable and well furnished in a homely style with good lighting. Outside the large gardens are attractive, well kept and has seating for residents. Residents said that they used the garden a lot in the summer months, and enjoyed them, especially the garden parties. Residents spoken with liked their rooms and improvements that had been made to the décor in the home. Many bedrooms had residents own possessions and this made them more personal and homely for the residents living there.
Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 15 There is a range of equipment to promote residents independence and comfort including adjustable nursing beds to help residents make the most of their independence and to get about the home. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The numbers and skill mix of care staff on duty are sufficient to meet resident’s needs. Procedures for the recruitment of staff are in place but do not provide clear records of appropriate checks being carried out to ensure adequate protection to people living in the home. EVIDENCE: The home has established recruitment procedures reflecting equal opportunities, they take up 2 references and the owner confirmed that staff have Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks before starting work. However there are no records of the CRB and POVA checks within the home. Staff members keep their own disclosure forms. The home must have a system that provided evidence and records the appropriate CRB and POVA checks have been done including disclosure numbers and proof of identity. Identification numbers with the Nursing and Midwifery Council (NMC) for registered nurses are being checked on recruitment but should be checked periodically to make sure nursing staff remain on the register. Records are kept of training attended by staff including inductions taking place in the home. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 and 38 Residents and visitors views are sought and they perceive that they have an effect on how the home is run and that the management and staff listen to and support them. Procedures are in place to safeguard resident’s financial interests and promote their health and safety. EVIDENCE: Although the home does not have regular residents meetings there was evidence from speaking to residents and visitors that they feel their opinions are valued. One resident said “ I don’t have to hold a meeting to say what I think” and they and others commented that they see and speak to either the Matron or the owner on a daily basis. Visitors in the home commented that they felt welcome and could be part of social events if they wanted. Satisfaction surveys are in use and reviews of procedures to promote quality monitoring. The provider is clear about his role and had a good relationship with staff and residents. Residents made positive comments about the staff and management
Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 18 team. One resident said staff are “ very, very caring and very friendly” and one said “I don’t think there are many more places better than this”. Records and servicing contracts indicated that the home has systems, training and practices to promote resident health and safety. Records showed that servicing and maintenance of equipment is being done. Staff have recently been given appropriate training on moving and handling. The owner confirmed that fire training was being done but there were no records available for inspection. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 2 Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13 (2) Requirement Evidence must be provided that the home has made arrangements for the safe dispose of medication through a licensed waste disposal company and is retaining records of the transactions The dose of medication administered must be documented on the chart where the dose varies. Evidence of CRB and POVA checks and proof of identity must be kept by the home. Evidence must be sent to CSCI. Evidence that staff are being given fire training at appropriate intervals must be forwarded to CSCI. Timescale for action 30/03/06 2. OP9 13 (2) 01/03/06 3. OP29 19 (4) Schedule 2 23 (4) 31/03/06 4. OP38 14/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 21 No. 1. 2. 3. 4. 5. 6. Refer to Standard OP3 OP9 OP9 OP9 OP18 OP29 Good Practice Recommendations Pre admission assessments should always be signed and dated by the person doing the assessment. The home should implement a system for identification of residents for medicines administration The pulse rate taken prior to administration of digoxin should always be recorded. Out of date or no longer required medication should be removed promptly. Staff should be given up to date training on adult abuse and adult protection. Periodic checks should be made on nursing staff personal identification numbers with the NMC. Hollow Oak Nursing Home DS0000050483.V262712.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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