Inspection on 07/02/08 for Hollow Oak Nursing Home

This inspection was carried out on 7th February 2008.

CSCI found this care home to be providing an Good service.

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

Hollow Oak Nursing Home 17/10/06

Hollow Oak Nursing Home 31/01/06

Hollow Oak Nursing Home 09/06/05

Hollow Oak Nursing Home 16/02/05

Hollow Oak Nursing Home 20/07/04

Hollow Oak Nursing Home 03/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hollow Oak Nursing Home Haverthwaite Ulverston Cumbria LA12 8AD Lead Inspector Marian Whittam Unannounced Inspection 10:00 7 February 2008 th 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.V350045.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. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 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 info@hollowoaknursinghome.co.uk 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.V350045.R01.S.doc Version 5.2 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 17th October 2006 Brief Description of the Service: Hollow Oak is a care home providing nursing care for 27 older people some of whom may have dementia. Hollow Oak is well established family business and the current owner has been in charge for many years. The home is in the South Lakeland 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 residents have a passenger lift but two bedrooms in the older part of the home 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 area that is also used as a lounge and informal seating area, there is also large extended lounge that incorporates a new conservatory that overlooks and leads out onto the patio and the attractive garden areas. There is also a quieter lounge/dining room and another smaller conservatory for service users. Outside there are large, well kept gardens to the side and rear of the home and these are accessible to residents and have appropriate seating. 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 many of the bedrooms. Fees payable at the home are up to £585.00. There are additional charges for personal toiletries, hairdressing and private chiropody. The home makes information about its services available through its service user guide and statement of purpose and inspection reports. These are available from the home. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes This site visit to Hollow Oak Nursing Home forms part of a key inspection. It took place over one day and we (The Commission for Social Care Inspection, CSCI) were in the home for seven hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager and provider identifying what the service does well and what could be improved. This was returned to CSCI before the visit. • The service history. • Interviews with residents and staff on the day of the visit. • Observations made by us in the home during the visit. • Completed survey forms from people living in the home, their relatives, health professionals and people using or coming into contact with the service. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files and medication records were examined and a selection of the service’s records required by regulation. What the service does well: People living in the home and their relatives gave very positive feedback on the service and care provided. One relative said “ It provides a happy family atmosphere where each person is treated with respect and as an individual. The staff are caring and polite”. The Matron and staff take time to help people settle into the home and make sure it suits them. The ethos of the home is to promote independence and to ensure those using the service maintain control of their own lives where they can. There is good communication with residents’ doctors so that health care needs are met promptly. One relative said, “ Residents know that if they are ill Matron and staff will go the extra mile to ensure their comfort.” Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 6 There are satisfactory systems for handling medication to make sure that medicines are managed safely and that residents receive the correct treatment. The management team and owners of the home present a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and the quality of life of residents living in the home. There is a consistent maintenance programme and high standards of cleanliness to keep a pleasant environment for the people living there. The service includes residents and families in how the home is run and supports people to achieve what is important to them. The home maintains a high standard of catering with fresh home made meals, reflecting resident’s preferences and choice. Efforts are made to ensure residents are offered a varied and nutritious menu with fresh fruit and vegetables available each day and meat from local suppliers. Residents and visitors spoke well of the home baking and the cakes at tea time. Staff are motivated to work to a high standard, and are well supported and supervised. Consequently staff morale and enthusiasm is high benefiting those who live there and their families. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. What has improved since the last inspection? A spacious and light extension has been built onto the former dining/lounge that can be used for a variety of activities and social events. It overlooks the garden which residents told us they enjoyed seeing. The area outside the new extension has been paved and is a suitably furnished and an attractive patio has been made that allows easy access to the garden areas for everyone. Residents told us how much they enjoyed the improved lounge. The new extension has made it possible to have a quieter lounge now that allows greater privacy for people receiving visitors. The home continues its programme of redecoration and refurbishment in bedrooms and communal areas. Activities are being done on a better-organised basis now with staff allocated to do this and at an individual as well as group level. Recruitment procedures have improved and checks are being done in a more efficient manner to safeguard residents. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 7 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. Hollow Oak Nursing Home DS0000050483.V350045.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 Hollow Oak Nursing Home DS0000050483.V350045.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): NMS 1, 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the service is available before and following admission so people have useful information and are able to make an informed choice. More care must be taken to ensure pre admission assessments are done to a consistent standard to ensure all an individual’s needs can be met when they come in. EVIDENCE: Information is available about the home for prospective residents and their families in the statement of purpose and service users guide so they know what the home can provide. These need to be generally updated to make sure they reflect the changes and improvements in the service and environment. People we spoke to who had recently come to live at Hollow Oak told us they had information and knew about the home and what it offered before they came. One person said someone who knew the service had recommended it to Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 10 them. Another person said they had a trial visit and liked it. They said they had been able to talk to matron and staff and ask questions about the service. This person told us how staff had helped them settle in and “were so kind, chatting and asking how I liked things done, after a week I felt like I had lived here for ages”. Survey responses also support the availability of information about the service. There are four to six week trial periods for people coming to live there, during which time the home continues to assess an individual’s needs and develop a care plan. Information is being gathered from other agencies and previous care settings and where appropriate a social services management plan is obtained and held on file for information. We looked at 6 pre admission assessments, including new residents, and the level of pre admission assessments that had been done by the service was not always consistent or detailed. For one person the assessment done by the home was incomplete and not signed or dated. For another person there was no record of an assessment being done by the home although there was some information on file from other agencies and care settings. The Matron must make sure that the pre admission assessments for prospective residents carried out by the service are done consistently and are always detailed and complete and signed and dated by the person making it. This will help to ensure a persons needs are fully assessed in a person centred way and their needs recorded before admission by someone qualified to do so. It leaves both the person and the home in a vulnerable position if staff do not having adequate assessment information to respond to individual needs on admission. The service does not provide intermediate care. Hollow Oak Nursing Home DS0000050483.V350045.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): NMS 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support and personal care which people using this service receive is based on their individual needs. Privacy, dignity and personal choice are promoted at all times. EVIDENCE: All residents have an individual plan of care and some personal and clinical risk assessments in place that had been reviewed and updated. The care plans were well organised, although not always in great detail. We talked with people using the service and one told us that staff, “Don’t do anything without asking us”. There was evidence in care plans and from speaking with people and from surveys that people are involved in making choices about their care and daily life and that discussion about the care and lifestyle they wanted took place between them and staff. This was evident in records for one person around the use of continence aids and another about the help they want for personal care. Residents confirmed that their opinions Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 12 are sought about their personal care and life in the home generally on a daily basis. One person told us “Nothing is too much trouble here, you only have to say”. Residents and their relatives say they feel privacy and dignity is respected and promoted by the staff and owner. We saw that staff were polite but friendly and informal as they helped people and chatted with them as they carried out their duties and activities. Staff demonstrated knowledge about the needs of the people living there and familiarity with their personal preferences including preferred names and daily routines. However this level of knowledge about aspects of health and social care was not always recorded in detail. The monitoring of some identified needs such as nutritional screening and psychological monitoring and some wounds were not always systematic or easy to follow. Monitoring needs to be clear in care planning. Information on progress is written in the daily records but this does not make it easy to get an overview of progress quickly for action. We discussed this with the manager who was aware that this had slipped and was addressing it and was looking at different ways to improve this in the plans and also how to make them more evidently person centred. Staff should not rely too heavily on using verbal communication about someone when supporting and giving care, as all relevant changes to care and personal information may not get passed on. To promote consistently good practice it should always be made clear in the care plan for all staff the action that needs to be taken to meet needs so nothing is missed. The owner is presently considering using computerised systems of care planning to improve the recoding of information and make sure all aspects of care are covered in detail. All the people we spoke to living there felt that their needs were being met and they were getting good care and the help they needed. One person told us that, “It’s really like a family here, and we all get along and know each other well”. People told us that their routines are flexible and they took their meals where they wanted, went out and saw family as they wished and got up and went to bed when they wanted.” There is evidence of timely referral to health care services and the actions taken following their involvement. This was particularly evident in the actions taken for one person with particular behavioural needs. Resident’s health care needs are being promptly attended to and the home works well with other agencies and health professionals to meet any identified needs. GP survey responses were all positive about the care provided and one said, “ Residents are treated as individuals and there is a family type atmosphere”. Medication practices and records are good overall and the storage of medicines and their handling is of a safe and consistent standard. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides social and leisure activities within the home and outside and there is a high standard of catering offering variety and choice to the people living there. EVIDENCE: All of the people living in the home we spoke with said they liked the food provided as did the surveys responses. One person told us “ the food is very good and I have been able to put on weight since I came here”. People told us they had a choice at all their meals and were always asked so they could have an alternative if they wanted it, although one person told us they “enjoy all the meals”. Some of the people we spoke to had chosen to have a cooked breakfast that morning and said this was always available. Other people told us how good the cook was and that their meals were prepared fresh each day with homemade soups and desserts and one said that the homemade cakes they had with afternoon tea were “especially delicious”. They also commented positively on the care taken with food at seasonal events such as the buffets Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 14 put on over Christmas and at the Christmas party, the Summer fete and birthdays during the year. The lunchtime meal was well presented and assistance was given discreetly to residents who needed it. Some residents chose to eat in their bedrooms, others in the dining room. We visited the kitchen and spoke with the cook who displayed a clear knowledge of people’s dietary needs and preferences and kept records of all meals served to people. People told us they could spend their time during the day as they chose and could take part in organised activities if they wanted to. Staff are allocated to run group activities on a daily basis. We saw a quiz underway in the large lounge during the morning and bingo during the afternoon both led by staff. People we spoke to confirmed that staff did this on a daily basis and several said they enjoyed the quizzes and bingo. Others told us they also used the library service and liked to listen to their own music in their rooms as well as take part in the organised musical entertainment and singers. Another person liked to knit and made woollen toys to sell for charity. They also told us that they could attend religious services of their choice, that local clergy came in monthly for services or the home would arrange for them to visit their own churches if they wanted to. The home had its own mini bus transport for residents. Relatives surveys indicated that activities are arranged in the home and one commented that, “Both residents and family are encouraged to take part in anything that’s going on”. Some care plans did not have detailed information on individual’s interests or recreational capabilities or personal profiles to support personal activity planning. We discussed this information with Matron who was aware of the need to do this and staff were already starting to develop personal profiles with people. We examined the ones that had been developed with people and their families and these presented good pictures of them as individuals. Staff need to continue to develop this for all the people living there. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service know they are secure and feel confident that their welfare and safety needs are always promoted. EVIDENCE: The home has a complaints procedure that is displayed in the home and complaints received are logged for investigation. People spoke highly of the Matron and owner saying they were easy to talk to and one said, ” I can tell them anything that is bothering me, I see at least one of them everyday”. People living in the home told us they were confident that Matron and the owner would deal with any complaints they made or take forward suggestions. The people we talked to in their own rooms and lounges felt free to express their views, which were all positive. People living there were aware how to make a complaint and relatives’ comments support this. One relative commented that, “It has never crossed my mind to complain as Mother’s care has been exemplary”. There have been no complaints received by the manager since the last inspection and CSCI has not received and concerns or complaints. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 16 There are procedures in place to protect vulnerable adults from abuse and for whistle blowing including multi agency guidance. Matron attended a training course on adult protection run by social services but as yet all staff have not had this updated training and it is recommended that it be given to make sure all staff are aware of current best practice. Prospective nursing and care staff undergo Criminal Record Bureau (CRB) checks to ensure their suitability to work in a care setting. The home does not deal with any resident’s personal finances and holds small amounts of money on their behalf. It is recommended that when money is with drawn that two people check and sign this to ensure good practice and reduce the risk of error. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment in the home is, clean, warm and homely with a consistently good standard of decoration and regular maintenance and refurbishment to ensure a safe and comfortable home for the people living there. EVIDENCE: The home is well maintained with a high standard of decoration throughout and provides a fresh, clean, tidy and homely environment for residents. Attention is paid to detail and making the environment welcoming and homely, the two lounges are arranged in a way that promotes groups rather than being institutional. A relative commented that,” The standards of cleanliness are very high even to the details of clean napkins and tray cloths”. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 18 The lounges and dining areas are spacious, comfortable and well furnished with good lighting and seating. The home has a rolling programme of redecoration and upgrading of bedrooms and communal areas and there is evidence of continuous maintenance of the property. Resident’s bedrooms that we saw had a high standard of décor, and furnishings. Many residents had brought some of their own possessions in with them and this made their bedrooms more personal and homely. The majority of bedrooms are single occupancy and are light and naturally ventilated with domestic type lighting. Outside the large landscaped gardens are attractive, well kept and well stocked with plants and have seating for residents. Residents told us that they use the garden a lot in the summer months, and enjoy it, especially when the fete is held. A new conservatory extension has been added to the former lounge/ dining room lounge and this is spacious and light. It overlooks the gardens and gives easy access out onto patio areas so that people living there can get out into the garden areas easily or look out onto it when the weather is bad. People we spoke to told us they had been consulted and kept informed about the new extension and one told us that, “The new extension is really lovely, it brings the garden into us”. There is already a small conservatory overlooking the garden that may be used by those who wish to smoke. There is a range of equipment provided to meet people’s needs, adjustable nursing beds, and adaptations to help residents make the most of their independence and to get about the home and call bells are accessible in areas used by them. There are infection control procedures in place and we saw staff using gloves and aprons during care and using appropriate clinical waste disposal. There are sluice facilities on both floors to promote infection control and a laundry with appropriate equipment. Staff have been given training on infection control previously but Matron should make sure this is updated to make sure all staff have current best practice information. Bathing and toilet facilities are of a good standard with suitable aids and adaptations and most bedrooms have en suite facilities. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient nursing and care staff on duty day and night to meet resident’s needs but lapses in the recording of training means staff may not be up to date with best practice. EVIDENCE: Staff rotas and observation of staff deployment during the visit indicate that the home has a stable staff group with a range of skills and experience to provide a consistently good level of individual care for residents. There is very little staff turnover and the home does not use agency staff. There are enough staff on day and night duty to meet people’s nursing and care needs and more staff at handover periods and to allow for activities to be supported during the day. Staff said that the rotas were “good” and usually six carers on during the day. Staff spoken with enjoyed their work, felt valued and supported by their manager and the organisation they worked for. The home now has more care staff undertaking NVQ Level 2 training in care and some doing level 3 NVQ in care. The assistant matron also has NVQ level 4 Managers Award to hep her in her management support role. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 20 The recruitment procedures have been improved and those in place help ensure that appropriate care staff support the people using this service. All legal checks are completed prior to the support workers starting work. Prospective staff complete application forms and written references are obtained by the manager at the agency. Interviews take place and identities are checked. Prospective staff undergo Criminal Record Bureau (CRB) checks, Identification numbers with the Nursing and Midwifery Council (NMC) for registered nurses are checked periodically to make sure nursing staff remain on the register. Appraisals have been done and supervision has been largely on an informal basis. It was recommended that when supervision is given it be recorded on individuals’ files. Records are kept of training attended by staff including induction however some records were not up to date so it was not possible to assess if all staff training was up to date or in need of refreshers. Training files we looked at did not show any recent moving and handling updates for staff, safeguarding adults training and infection control training. This training and records need to be brought up to date so people living there can be sure staff have training in line with current best practice. We discussed this with the Matron who acknowledged that monitoring and record keeping had lapsed in relation to training and that a better system of quality assurance in this area was needed. Staff training needs to be consistently monitored to make sure it has not been missed or is need of updating to reflect best practice. It was recommended that a thorough review be carried out on all staff training with a system in place to make sure it is done on time and all records brought up to date and any training or updates required organised for the staff affected. Staff files did show that some staff have attended a range of other training including a palliative care foundation course with a local hospice and dementia awareness training. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and promote their health, welfare and safety. EVIDENCE: The Matron is qualified and experienced and is focused on providing a high standard of care for people living there. She is very focused on outcomes for people and is very hands on in nursing and care practice working alongside staff. Senior staff are well supported by the provider who takes an active role in day-to-day issues and getting residents’ views. The manager has identified areas where the service performs well and recognises areas that require Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 22 improvement and demonstrates the ability to act upon these and seek appropriate advice. The service generally operates in the best interests of the people living in the home and seeks their individual opinions on things that affect them. The people living there told us that the provider and the Matron are approachable and responsive to feedback and they see them most days. We discussed development of the service with the provider who outlined future development to improve facilities for the people living there. The management continues to develop their quality assurance system and although the home does not hold regular residents meetings there is evidence from survey responses, speaking to residents and relatives that they feel their opinions are valued and affect the way things are done in the home. Relatives commented that they felt welcome when they visited and could be part of social events if they wanted. Satisfaction surveys are in use and reviews of procedures to promote quality monitoring. Matron audits medication and care plans on an informal basis to promote consistently and identify any gaps in care. The audits and reviews undertaken should be more formalised and recorded as part of overall quality monitoring processes and the actions to be taken. Records and servicing contracts indicate that the home has systems, risk assessments, fire training and safety practices to promote resident health and safety. Records indicate that residents’ financial interests are safeguarded and promoted. Records show that servicing and maintenance of equipment is being done as needed. During examination of records and discussions with the matron we could see that Matron spent a lot of time working as part of the nursing team and whilst this was good from a supervisory and support perspective it left little time for office work and keeping up to date with administrative matters and providing training. We recommended that dedicated time be provided to allow her to fulfil this management role as well and effectively as she did her practical nursing duties. Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 23 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 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 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 3 2 X 3 2 X 3 Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 (1) Requirement The registered person must make sure all people using the service have been fully assessed before admission by someone qualified to do so and can confirm the home is suitable and able to meet the person’s health and welfare needs. Timescale for action 10/03/08 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. Refer to Standard OP1 OP7 Good Practice Recommendations The statement of purpose and service user guide should be updated to reflect the changes within the service. To promote consistently good practice all actions to be taken by staff should be fully detailed in the care plans. Monitoring of nutritional and psychological needs and wound care should be on a continuous basis and consistently recorded in people’s plans so progress can be reviewed easily. DS0000050483.V350045.R01.S.doc Version 5.2 Page 25 OP8 Hollow Oak Nursing Home 4. OP18 It is recommended that when residents’ money is withdrawn from safekeeping that two people check and sign this to ensure good practice and reduce the risk of errors. A review of all training to date and training records should be undertaken and a system put in place to make sure all staff have appropriate up to date training to do their work. Moving and handling, infection control and safeguarding vulnerable adults training should be brought up to date to protect residents’ welfare. A review of all training to date and training records should be undertaken to make sure all staff have appropriate up to date training to do their work. Moving and handling, infection control and safeguarding vulnerable adults training should be brought up to date to protect resident’s welfare. Staff supervision should be recorded to make sure it is done consistently. 5. OP30 6. OP33 7. OP36 Hollow Oak Nursing Home DS0000050483.V350045.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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