Inspection on 09/06/05 for Hollow Oak Nursing Home

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 07/02/08

Hollow Oak Nursing Home 17/10/06

Hollow Oak Nursing Home 31/01/06

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 09 June 2005 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 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 F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hollow Oak Nursing Home Address Haverthwaite Ulverston Cumbria LA12 8AD 015395 31246 015395 30202 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hollow Oak Nursing Home Limited Angela Peachey King Care Home 27 Category(ies) of OP - Old Age registration, with number DE(E) - Dementia, over 65 of places Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 2. 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 16 February 2005 Brief Description of the Service: Hollow Oak is home providing care for 27 older people requiring nursing and personal care. 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 is on two of the floors. The floors used by service users have a passenger lift but two bedrooms that 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 home’s 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 F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 9th June 2005 and lasted 5 hours. Time was spent touring the home, speaking with residents individually in their rooms and in groups and also speaking with visiting relatives, with staff and the owner. What the service does well: What has improved since the last inspection? The home continues to work hard to improve furnishing and décor and plans to further improve adaptations to promote access for residents to areas of the home with stairs. Dementia training has been provided to improve staff understanding and awareness of this condition. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 6 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. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 8 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 standard(s) 3 and 4 The standard of the pre admission assessments done by the home has fallen and is not sufficiently detailed to ensure individual needs could be met on admission. Without this there is no assurance that the needs of all residents can be met when they come into the home. EVIDENCE: Individual care records are kept for each resident and inspection of the pre admission assessments for 4 residents, provided by staff, did not have a full pre admission assessment information recorded for them but only basic information. More detailed information is needed to assess if needs could be properly met and managed when a person came in the home. This was evident for a resident with a feeding tube whose healthcare needs were not fully met following admission. There was information provided by other agencies at admission on the files and there was evidence of the involvement of other services in care where a need had been identified and stated in the plan. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 9 Despite assessments lacking detailed information the inspector spoke with residents who felt that their needs were being met as they wanted. Two visiting relatives spoken with expressed their confidence in the home to meet the needs of their family members. Some residents with higher levels of dependency and nursing needs could not give an opinion to the inspector as to whether or not they thought their individual needs were being met. Their records were examined and had inadequate records of pre admission assessments upon which to base their care plans. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 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 standard(s) 7, 8 and 10 The care planning system is not consistent to provide staff with the up to date information they need to meet all service user needs. As a result staff had not always been certain what to do to meet some residents needs. Personal support was being offered in the home in such a way as to promote individual dignity and privacy. EVIDENCE: All residents had a plan of care and some personal and clinical risk assessments. However, there are some aspects of the health and personal care needs of residents that had not been assessed and recorded in the care plan and the management planned for or potential risks assessed on admission. This was evident for one resident who said they had come into the home because of a history of falls but had no risk assessment in their care plan with particular attention to the prevention of falls. It was also evident for one resident who needed a feeding tube to get their food. There were no instructions on the nursing care in the care plan at the time of the incident about the care of the site and managing problems There are no clinical policies and procedures in place regarding the management of such feeding tubes to guide staff on the correct procedure to Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 11 follow. As a result staff had been unsure of what to do when problems occurred and there was a delay in getting hospital or medical care. Reviews had not been done regularly for all residents to reflect changing needs and care objectives and actions to be taken. This was evident for one resident where daily records noted “a broken area on buttock but this was not updated in the care plan to show a changing need and objectives for care. There was a lack of nutritional assessments routinely in place for residents whose conditions affected their ability to take food and drink. Care plans must assess and record nutrition and a resident’s ability to obtain proper nutrition and fluids and actions taken. Residents are at risk of not having all their health care needs met if there is no system for monitoring a situation and clear guidance for staff on objectives. Residents spoken with felt their privacy was respected and they were treated as they wished during care. A relative said their relative was “really well cared for”, and “residents were treated as individuals and with great dignity”. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 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 standard(s) 12,13, 14 and 15 The home provides regular social activities and staff supported residents well in individual activities and to maintain outside contacts. Food in the home offered a good variety and choice and catered for special dietary needs. EVIDENCE: The home provided regular activities and organised social and religious events. Residents talked about the musical entertainments provided from outside and within the local community and the annual fete .A member of staff was designated in the afternoons to help residents with individual and group activities and exercise. Some residents said that they preferred to follow their own interests and spend time in their rooms reading, knitting, one liked to “potter about in the garden” and “pot up plants” another liked to watch the birds in the garden. One resident told the inspector that they were “past the hobby age” but just liked the “peace and quiet in the home”. Some said they went out with their families and friends. Relatives spoken with said they could attend events and were made welcome in the home. Residents said that they could come and go as they pleased and see who they wanted to. The home had its own transport for residents. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 13 Residents spoken with made positive comments about the food in the home and the high standard of catering. Those spoken with felt the food was “excellent” and “very good” and spoke of the “excellent Sunday roasts” and the food provided for “special occasions”. All agreed there was a choice of food each day and that there was always plenty to eat and drink available and their comments on food and preferences were listened to. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 14 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 standard(s) 16 and 18 The home has a satisfactory complaints system that was displayed in the home. Residents felt confident that the manager would listen to them and act to deal with their concerns. Systems were in place to protect residents from abuse. EVIDENCE: The home has a complaints procedure and logged formal complaints for investigation and the procedure was available to residents. Residents and relatives spoken to were confident that the manager and owner would deal with any complaints they made. There were procedures in place to protect vulnerable adults from abuse and for whistle blowing including multi agency guidance and these were available for staff in the home. There were procedures on handling aggression to guide staff. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 15 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 standard(s) 19,20,22,23, 24 and 26 The standard of décor in the home was satisfactory with evidence of regular maintenance and improvements and more planned. The home provided a clean, comfortable and homely environment for residents to live in and had the equipment they need to promote mobility and independence. 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 were comfortable and well furnished with good lighting. New furniture was on order as part of the ongoing maintenance and refurbishment planning. 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. There are facilities for residents who want to smoke that do not affect other residents. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 16 Resident’s bedrooms seen by the inspector had a high standard of décor and furnishings. Many rooms had residents own possessions and this made them more personal and homely for the residents living there. There is a range of equipment, nursing beds and adaptations in the home to help residents make the most of their independence and to get about the home. There were plans to provide more adaptations to further improve resident access to areas with stairs. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers and skill mix of nursing and care staff on duty were adequate to be able to meet resident’s needs. EVIDENCE: Staff rotas and observation during the visit suggested that the home had a stable staff group providing continuity for residents and enough staff on duty to provide adequate nursing and care during the day and night. Staff spoken with enjoyed their work and morale was good. Residents and visiting relatives said that staff and management were “caring” and that “nothing was too much trouble” and that staff responded quickly when they rang for them. Staff covered shifts if there were any unexpected shortages. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30, 31, 32, 34, 35 . The owner has a clear development plan for the home, which is communicated to residents and staff and the manager is supported well by the staff and owner to meet the home’s objectives and safeguard resident’s interests. However the systems for consultation with relatives are inconsistent so residents close family may not be consulted about of changes to their care and condition so processes do not always reflect openness and transparency. EVIDENCE: The provider was clear about his role and had a good relationship with staff and residents. Staff spoken to felt supported by the management team and one said that Matron was “very good”. Residents made positive comments about the staff and management team. One resident said they were “caring and thoughtful” and “couldn’t do enough for you”. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 19 Staff training was supported and where training gaps had been identified in response to a problem, such as in dementia care and PEG feeding this had been attended to prevent problem arising again. Residents spoken with said that they saw the Matron and the owner most days and they felt happy to raise issues with them and get their views across. Residents and visiting relatives spoken with commented positively on involvement in the daily life of the home. However, entries in the daily records indicated that close relatives had not been told promptly following an event affecting a resident’s healthcare and nursing management. Provision must be made to consult with close family/representatives when changes occur that have an effect on a resident’s health and wellbeing. There was no record in the care plan that the resident did not want their family consulted about changes. Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 x 3 3 x x x Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? 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 A full needs assessment must be undertaken and recorded beforen admission to ensure residents needs can be met in the home before they are admitted Care plans must set out in detail the actions that need to be taken by staff to meet all aspects of residents health, personal and social care needs. Care plans must be kept under review, evaluated and updated to reflect changing needs, risks and current objectives for health and personal care. Access to health care services must be prompt. Nutritional screening must be done on admission and monitored to reflect cahnging needs. The home must have procedures in place that reflect clinical good practice on the care to give. Provision must be made for consultation with service users representatives/ close family following events affecting their wellbeing. Timescale for action 1.7.05 2. OP7 15 (1) 7.7.05 3. OP7 15 (2) 7.7.05 4. 5. OP8 OP8 13 (1) 14 (1) (2) 17 (1) Schedule 3 12 (1) 24 (1) 1.7.05 1.7.05 6. 7. OP8 OP32 14.7.05 1.7.05 Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 22 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 Good Practice Recommendations Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 23 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 © 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 Hollow Oak Nursing Home F58 F10 s50483 hollow oak v226911 090605 ui stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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