Inspection on 19/01/10 for Holly Bank House

This inspection was carried out on 19th January 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holly Bank House 08/12/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 11/04/2010.

Random inspection report Care homes for older people Name: Address: Holly Bank House Royston road Churchinford Taunton Somerset TA3 7RE new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: kathy McCluskey Date: 1 9 0 1 2 0 1 0 Information about the care home Name of care home: Address: Holly Bank House Royston road Churchinford Taunton Somerset TA3 7RE 01823601447 01823602816 alutarius@aol.com www.alutarius.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Alutarius Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 22 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 22. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Hollybank Nursing Home is situated in the village of Churchinford which has a pub and small shop. The town of Taunton is approximately 7 miles away. The home is registered with the Care Quality Commission to provide general nursing Care Homes for Older People Page 2 of 18 Brief description of the care home care to up to 22 older people. The home is not registered to provide a service to people where their primary care needs are their dementia or other mental health problems. Earlier this year the home approved an application for Alutarius Ltd to become the registered provider. The responsible individual is Mr Neil Plummer. The registered manager has recently left this post and the home is currently without a registered manager. Up to date information about fees should be obtained from the home. Care Homes for Older People Page 3 of 18 What we found: The purpose of this unannounced random inspection was to follow up on the homes progress in meeting the requirements and immediate requirements raised at the key inspection conducted in December 2009. At the time of this inspection, not all timescales for action had passed and these will be examined at a further inspection. Since the last inspection concerns had been raised with the Commission regarding staffing levels and the lack of ancillary staff. The acting manager was present throughout this inspection and we were informed that twelve people were residing at the home. At the last inspection we raised concerns about an individual who had lost a significant amount of weight and was experiencing difficulties in taking diet and fluids. A nutritional assessment had not been completed and the home were not monitoring the individuals diet and fluid intake. We issued an immediate requirement which required the registered person to address these concerns within 48 hours. At this random inspection we reexamined the care records for this individual. We found no evidence that a nutritional care plan had been raised. The acting manager when asked, confirmed that a nutritional care plan had not been completed. This is concerning especially as the home has high agency staff usage. A MUST tool was in place which gave an overall score of 2. This tool gave no information as to what the scores meant. We were able to see evidence that the home had been monitoring diet and fluid intake though we have recommended that more detailed information is recorded so that the actual amount taken can be fully monitored. The entries currently recorded did not identify the amount taken; eg: half a cup of tea, white toast, fruit juice. A body mapping chart had been completed which identified the individual as having two wounds. The wound evaluation sheet in place did not contain information about the size of the wounds nor did it identify the agreed/prescribed treatment, frequency or date for review. Entries made by the registered nurses did not demonstrate a consistent approach to the frequency of the dressing being changed or the type of dressing in place. A care plan had not been raised and a pressure sore risk assessment had not been completed. We examined two additional care plans for people who were having their diet and fluid intake monitored. As previously mentioned, more detail needs to be recorded regarding the amount of diet and fluid actually taken. Nutritional care plans were in place though one made no reference to the fact that the individuals diet and fluid intake were being monitored. The other care plan had not been updated to reflect that the individual was receiving supplements or that they required a high protein and high calorie diet. On examination of the daily records for one individual we found that reference to a catheter had been made. A care plan had not been raised to address this. A pressure sore risk assessment had been completed which identified the individual as being at very high risk of developing pressure sores. A care plan had not been raised to address this need. We were able to see evidence that the home had taken appropriate action to ensure that appropriate assessments were completed to identify peoples moving and handling needs. Care Homes for Older People Page 4 of 18 We were informed that no new staff have been employed since the last inspection therefore we were not able to follow up on the requirement issued at the last inspection relating to the homes staff recruitment procedures. We did follow up on the requirement relating to shortfalls in recruitment procedures for staff already in post. We found that the registered person had not fully complied with this requirement. There was no evidence that the expired pin numbers of two registered nurses had been verified with the NMC. A photo ID was still not in place for one staff member. As required, a second reference for one employee was now seen to be in place though there was no evidence of a documented verbal reference which the registered person had indicated was in place. The recruitment file for another identified staff member was not available at the home and we were informed that the discrepancies identified at the last inspection were being examined by the companys head office. We were informed that the home does not currently have any domestic or laundry staff and that these duties are completed by the registered nurses and care staff during the afternoon. We were also informed that a cook is on duty 7 days a week but that this only covers the lunch time period. We were informed that breakfast and tea duties are currently undertaken by the registered nurses and care staff on duty. On discussion with staff, it was apparent that these additional duties were impinging on their care and nursing duties. We were informed that the day following this inspection, a cleaning agency would be providing domestic cover from 0800-1400hrs 5 days a week for a period of three weeks whilst the home advertise the post. We were informed that the home continue with high agency staff usage. On the day of this inspection the acting manager was on duty along with a carer and an agency nurse. We were told that nights are covered by a waking registered nurse and one carer. We were informed that of the 12 people residing at the home, 4 people currently required the assistance of 2 staff to meet their moving and handling needs. The registered person must ensure that staffing levels are sufficient to meet the dependency levels and numbers of people using the service and that sufficient ancillary staff are employed. At the last inspection the registered person was required to ensure that monthly unannounced visits to the home are conducted in line with Regulation 26 of the Care Homes Regulations 2001, with written reports to be maintained at the home. We were unable to see evidence that this had been addressed. What the care home does well: What they could do better: As previously mentioned, given that not all timescales had passed, we did not follow up on all requirements raised at the last inspection. This report relates only to the issues examined at this inspection. The home needs to make improvements on its care planning procedures so that care plans are raised to address individuals assessed needs. Care Homes for Older People Page 5 of 18 Wound management procedures also require improvements so that people receive a consistent approach and so that the progress of any wounds to be properly monitored. Pressure sore risk assessments must be completed and care plans must be raised where there is an assessed need. Staffing levels must be sufficient to meet the dependency levels and numbers of people using the service. The home also need to ensure that sufficient ancillary staff are employed. The registered person must ensure that the quality of the service provided is appropriately monitored and improved through monthly unannounced visits in accordance with Regulation 26 of the Care Homes Regulations 2001. Staff recruitment procedures need improvements so that people are protected from the risk of harm or abuse. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 18 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 4 18 (1)The registered person 31/01/2010 must ensure that at all times suitably qualified, competent and experienced persons are working at the home This is so that you are able to demonstrate the homes capacity to meet the needs (including specialised needs) of individuals admitted to the home. 2 7 15 (1) The registered person 31/01/2010 must ensure that up to date care plans are in place which clearly identify how an individuals assessed needs are to be met. This includes any psychological needs. This is to ensure that the assessed needs of individuals can be met. 3 8 12 (1) The registered person 31/01/2010 must ensure that appropriate assessments are in place and that care plans are raised to address peoples nutritional needs. This is to ensure the health and welfare of people using the service. Care Homes for Older People Page 7 of 18 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 8 12 (1) The registered person 10/12/2009 must ensure that appropriate nutritional assessments and a plan of care are in place to address the nutritional needs of the identified person using the service. This is to ensure that the individuals health care needs are met. 5 8 12 (1) The registered person 31/01/2010 must ensure that appropriate assessments are in place to reduce the risk of pressure sores and that care plans are raised to address an assessed need. This is to ensure the health and welfare of people using the service. 6 9 13 (2) The registered person 31/12/2009 must ensure that any changes to an individuals prescribed medication is authorised by the prescriber. This is to ensure the safe administration of peoples medication. 7 9 13 (2) The registered person must ensure that all medicines (except those requiring refridgeration) are stored at a temperature not exceeding 25c. This is because medicines can be affected if stored at temperatures above 25c. 05/02/2010 Care Homes for Older People Page 8 of 18 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 8 18 13 (6) The registered person 31/03/2010 must take appropriate action to ensure that all staff receive up to date training in the protection of vulnerable adults and that they are aware of action to be taken should they suspect any form of abuse. This is so that people using the service are protected from the risk of harm or abuse. 9 27 18 (1) The registered person 31/01/2010 must ensure that the status of registered nurses is checked with the Nursing and Midwifery Council (NMC). This is so that at all times, suitably qualified nurses are on duty at all times. 10 29 19 &Schedule 2. The registered 05/01/2010 person must take action to ensure that all required information for employees identified at this inspection is in place/completed by the date shown. This is so that people using the service are not placed at risk of harm or abuse. 11 29 19 (1) The registered person 05/01/2010 must ensure that staff do not commence employment until two satisfactory references have been applied for and obtained by the home and that the employer is satisfied Page 9 of 18 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action to the authenticity of the references. This is to ensure robust staff recruitment procedures are followed and so that people are not placed at risk of harm or abuse. 12 29 19 &Schedule 2. The registered 08/12/2009 person must ensure that staff do not commence employment until all required information has been obtained. This is so that people using the service are not placed at risk of harm or abuse. 13 30 18 (1) The registered person 31/01/2010 must ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers as are appropriate for the health and welfare of people using the service. This relates to the completion of an appropriate induction programme and mandatory training for newly appointed staff. This is so that the needs of people using the service are fully met. 14 31 10 The registered person must make arrangements to ensure the home is effectively managed by a person who has the skills, experience and training 22/01/2010 Care Homes for Older People Page 10 of 18 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action needed. To ensure that the home is effectively managed 15 33 24 (1) The registered person 19/02/2010 shall establish and maintain a system for reviewing and improving the quality of the care provided. The home should seek the views of people using the service and other stakeholders. This is so that people receive an improved quality of service. 16 33 26 (2-5). The registered person 31/12/2009 must ensure that a responsible individual visits the home on a monthly unannounced basis in accordance with this regulation. Written reports must be maintained at the home. To ensure the quality of the service is monitored and reviewed. 17 36 18 (2) The registered person 31/01/2010 must ensure that staff are appropriately supervised. Staff should receive formal supervision at least six times a year with records maintained. This is so that staff are appropriately supported and that any training needs can be identified and actioned. Care Homes for Older People Page 11 of 18 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 18 38 13 (4) The registerecd person 31/03/2010 must ensure that all existing staff receive up to date mandatory training. This is to ensure the health, safety and welfare of staff and persons using the service 19 38 37 The registered person must ensure that the Commission is notified of all significant events at the home as detailed in this regulation. This is so that the Commission are aware of all significant events at the home including any deaths. 22/01/2010 20 38 13 (4) The regsitered person 22/01/2010 must supply the Commission with evidence of up to date servicing/checks for: All mobile and bath hoists, the shaft lift, portable electrical appliance checks, and external servicing for the homes fire alarm/detection systems This is to ensure the health and safety of all persons at the home. Care Homes for Older People Page 12 of 18 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) The registered person 22/02/2010 must ensure that wound management assessments contain information about the size & status of the wound, details of the agreed/prescribed treatment, frequency of treatment and date for review. This is so that treatment is delivered in a consistent manner and so that the progress of the treatment can be fully monitored. 2 7 15 (1) The registered person must ensure that care plans are in place to address all identified assessed needs This is so that staff are aware of, and know how to meet peoples assessed needs. 19/02/2010 3 8 12 (1) The registered person 14/02/2010 must ensure that appropriate nutritional assessments and a plan of care are in place to address the nutritional needs Page 13 of 18 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action of the identified person using the service. PREVIOUS TIMESCALE OF 10/12/2009 NOT FULLY MET. This is to ensure that the individuals health care needs are met. 4 27 18 (1) The registered person 26/02/2010 must ensure that staffing levels are sufficient to meet the assessed needs and numbers of people using the service. This is so that people receive care in line with their assessed needs and to ensure the health and welfare of people using the service. 5 29 19 &Schedule 2. The registered 15/02/2010 person must take action to ensure all required information for employees identified at this inspection is in place/completed by the date shown. PREVIOUS TIMESCALE OF 05/01/2010 NOT FULLY MET. This is so that people using the service are not placed at risk of harm or abuse. 6 33 26 (2-5) The registered person must ensure that a responsible individual visits the home on a monthly unannounced basis in accordance with this regulation. Written reports 15/02/2010 Care Homes for Older People Page 14 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action must be maintained at the home. PREVIOUS TIMESCALE OF 31/12/2009 NOT MET This is to ensure the quality of the service is monitored and reviewed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information about the home should be updated to reflect the current management situation. This was not assessed at this inspection. Peoples care plans and assessments should be reviewed at least monthly to ensure they remain reflective of their needs. Not assessed at this inspection. The home should ensure that people are weighed at least monthly so that any concerns can be identified and actioned. Not assessed at this inspection. The home should ensure that information recorded on peoples diet and fluid intake contain more detail on the amount of diet and fluid actually taken. To reduce the risk of errors, hand transcribed entries on individuals medication administration records (MAR) should be confirmed with two staff signatures. Not assessed Because creams/lotions have a limited shelf life once opened, any items in use should be marked with the open/expiry date. Not assessed. To ensure the safe storage of medicines the home should monitor and record the temperature of the room storing medicines on a daily basis ensuring that the temperature Page 15 of 18 2 7 3 8 4 8 5 9 6 9 7 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations does not exceed 25c. The actual, minimum and maximum temperature of the medicine fridge should be recorded daily to ensure temperatures remain within acceptable limits of 4-8c. Not assessed. 8 9 The home should liaise with the prescriber and request more information to be provided as to what a medicine has been prescribed for and how many times a day it should be administered. Not assessed. To promote peoples dignity, the home should store peoples incontinence aids more discreetly. Not assessed. To further promote independence and choice for people, the home should (where appropriate) consider the use of serving dishes for the main meal rather than offering plated meals. The registered person should ensure that people using the service, staff and any visitor to the home are fully aware of the homes complaints procedure. Not assessed. The registered person should ensure that the current arrangements for the storage of hoists, wheelchairs and linen are kept under review so that they do not pose a risk to the health and safety of persons at the home. Documented risk assessments should be maintained at the home. The home should ensure that additional ancillary staff are employed so that registered nurses and care staff are able to better carry out their care/nursing duties. The registered person should review the current application for employment form so that it requests applicants to provide at least 10 years employment history. Any gaps in employment should be explored and reasons documented. Not assessed. The registered person should ensure that staff undertake a 12 week induction programme which follows the recommendations of the skills for care common induction standards. Not assessed. Page 16 of 18 9 10 10 15 11 16 12 19 13 27 14 29 15 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 16 38 The registered person should ensure that weekly in-house checks are maintained on the homes fire alarm/detection systems and that monthly checks are maintained on the homes emergency lighting. Not assessed. Care Homes for Older People Page 17 of 18 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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