Inspection on 14/08/07 for Holly Bush Nursing Home

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Holly Bush Nursing Home 20/06/06

Holly Bush Nursing Home 08/11/05

Holly Bush Nursing Home 11/05/05

Holly Bush Nursing Home 13/01/05

Holly Bush Nursing Home 18/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Holly Bush Nursing Home 99/101 Gordon Avenue Stanmore Middx HA7 3QY Lead Inspector Judith Brindle Key Unannounced Inspection 14th August 2007 09:10 X10029.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 Holly Bush Nursing Home DS0000022927.V344015.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 and Care Homes for Adults 18 – 65*. 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. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Bush Nursing Home Address 99/101 Gordon Avenue Stanmore Middx HA7 3QY 020 8420 7256 020 8954 1446 karen@hollycaregroup.com 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) Holly Bush (UK) Limited Mr Emmanuel Dick Essel Care Home 12 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (3), Learning disability (12), Learning disability of places over 65 years of age (12) Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Minimum Staffing notice The staffing of the home is increased to ensure that there are 3 care staff on duty with the registered nurse for both morning and afternoon/evening shifts when service users are back from day care. Holly Bush Nursing Home is registered for learning disability over 65 years of age as well as learning disability 45-65 years of age. 20th June 2006 2. Date of last inspection Brief Description of the Service: Holly Bush Nursing Home is a registered care home providing nursing care and accommodation for up to 12 service users with learning disabilities over 65 years of age as well as adults with a learning disability 45-65 years of age, and up to three of those people using the service over the age of 65years old with dementia care needs. The registered provider is Holly Bush (UK) Limited. The care home is located in a residential area, close to the local amenities and facilities of Stanmore and Harrow Weald. These amenities include shops; restaurants, banks and parks. Public transport facilities consist of bus and train services. There are ten single rooms and one shared room. No bedrooms have ensuite facilities. The bedrooms are situated on the ground floor and first floor. Bathroom facilities are located on both floors. The home has a passenger lift. The home has an enclosed accessible maintained garden. The care home has accessible documentation containing information about the service it provides. Information about the range of fees, including additional charges can be obtained from the provider, and is recorded in service users’ statement of terms and conditions documentation. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during a day in August 2007. There were four vacancies at the time of the inspection. The purpose of the inspection was to spend time with the residents, assess 24 National Minimum Standards, and to follow up and assess as to whether requirements and recommendations from the previous inspection had been met. The inspection included a tour of the premises, and inspection of resident’s care plans, staff personnel records, medication storage and administration systems, and inspection of a variety of other records. The inspector also spent a significant part of the inspection talking with staff, and people using the service, and observing interaction between residents and staff. The verbal communication needs of the residents are varied. Some residents used gestures and sounds as their main method of communicating their needs. Observation was a significant tool used in the inspection process. Information and evidence was also obtained from the home since the last key inspection in 2006, which included notification of significant events, and information from completed monthly audits carried out by the operations manager. The registered manager was present during the inspection, and the care home’s operations manager was present during part of the inspection. Staff kindly provided all the information, and documentation requested by the inspector during the inspection. Requirements from the previous inspection were judged as having been met. The inspector thanks all the people living in the care home, and the staff for their assistance during the inspection process. What the service does well: The care home has a very welcoming atmosphere. Residents live in a homely environment. A person living in the home was very positive about the care home and staff, and confirmed that they were all happy living in the home. Residents’ contact with relatives and others is fully supported and enabled by the care home. A visitor spoke very positively about the care and support provided for his/her relative. The registered manager is experienced, and he ensures that there is liaison with healthcare professionals and other specialists as and when required/needed by the residents. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 6 Day trips for residents are a regular feature of the care home. Staff receive varied and appropriate training to ensure that they are skilled in carrying out their roles and responsibilities. Observation and talking to staff indicated that staff were aware of resident’s individual needs and interacted in a respectful and sensitive manner with people using the service. What has improved since the last inspection? 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. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3 (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective people wishing to move into the home to have the information that they need to make an informed choice about where to live. The format of this documentation could be developed to improve its accessibility to people using the service. Arrangements are in place to ensure that prospective resident’s needs are assessed. EVIDENCE: Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 9 It was evident that people using the service had been supplied with a copy of the statement of purpose/service user guide. The registered person should develop ways of improving the format of the service user guide to increase its accessibility to the residents, all of whom have multiple needs including communication needs. The operations manager spoke of how the provider was in the process of developing and improving the accessibility of a variety of documentation for people using the service. The provider has at present a ‘block’ contract with the Local Authority for the placements in the care home. The information in regard to the fees paid was available for inspection. The care home has an admissions policy. A care plan of a resident recently admitted to the home confirmed that the manager had carried out a comprehensive initial assessment of the resident, and had included information from a previous placement. The care plans inspected recorded little evidence of up to date assessment information from the funding Local Authority. The registered manager should ensure that this information is obtained and documented in the residents care plans. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9, and 10 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all people using the service have a plan of care, which sets out their health, personal and social care needs. The content and the format of care plans could be improved. Residents are treated with respect. Risks and guidance to minimise identified risks could be better documented, to help people using the service to lead the life that they want. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 11 Medication is stored and administered safely, but there are issues in regard to the supply of some medication that needs to be resolved. EVIDENCE: All the people using the service have a plan of care. Four care plans were inspected. These included some clear guidance to ensure that staff meet the assessed needs of the people using the service, but there was generally little evidence that this guidance had been up dated and reviewed. There needs to be more evidence that resident’s recorded goals/objectives (short term and long term) are reviewed and evaluated regularly. Though staff had signed sections of the care plans, there was no indication that people using the service had been involved in their care plan nor recorded as to how much they were able to be participate in its development, and review. For example staff had signed guidance, but generally people using the service did not sign this, nor was it indicated if they were unable to sign. The registered manager should also examine and develop ways of ensuring that all staff, relatives/significant others (if agreed by the resident) are involved in the care plan and its review. Care plans could be further developed in regard to meeting the often complex and multiple needs of the residents. The care plan should be a ‘working document’, and be more person centred, and include detail of how each resident’ aspirations, are to be met. The format of the care plans should include evidence of a variety of different and creative methods to help people who use the service to contribute to the development of their care plan, and the ongoing process of review. The operations manager reported that there were plans to develop and improve this documentation. Risk assessment documentation indicated that some risks in some care plans such as risk of falls, moving and handling, and personal risk assessment indicated more than minimal/low risk but that there were not always recorded staff guidance to minimise this identified risk. The manager reported that recent training had been given to staff to improve and to develop their report/record writing skills, and that this is monitored closely. Records confirmed this. Records confirmed that residents have their health needs monitored, and have access to care and treatment from a variety of healthcare professionals. These include GP and tissue viability nurse appointments, optician, dentist, chiropody and psychiatric care. Residents as needed, access additional specialist support and advice. Residents weight is monitored. Records and staff confirmed that some residents have bedrails. There needs to be evidence that appropriate risk assessments have been carried (with the resident, family significant other (i.e. health and/or social care professional) out in regard to their safety. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 12 Staff were observed to interact with residents in a sensitive and respectful manner during the inspection. A resident spoke of choosing her own clothes. The care home has a medication policy/procedure. The medication storage and administration systems were inspected. Medication is stored securely. The registered nurse on duty administers medication. The manager spoke of regularly monitoring the administration of medication procedures. Medication administration records were inspected. There were records, which indicated that some resident’s medication has not been given due to it not being available. The manager spoke of on going issues of not receiving appropriate amounts of medication particularly liquid medication,which is prescribed by the GP practice. The manager needs to be proactive in ensuring that residents receive the appropriate amounts of medication for the time between deliveries from the pharmacist, and to take appropriate action including involving senior management in this issue. The manager spoke of having involved the GP practice manager and the community pharmacist in this matter. People using the service must have access to all medication prescribed to them, and appropriate prompt action by the registered person needs to take place if a resident ‘runs out’ of medication. The date of opening of eye drops bottles needs to be recorded. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the care home have the opportunity to take part in a variety of preferred activities, but these could continue to be further developed. Arrangements are in place to enable people living in the care home to maintain contact with family/significant others, as they wish. People living in the care home have their rights respected Arrangements are in place to ensure that people using the service choose meals, which are varied and wholesome, and meet the cultural and dietary needs of the residents. . Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 14 EVIDENCE: The residents each have an individual activity programme, which is recorded on a weekly basis. Records indicated that not all residents had an up to date activity programme. Staff ‘tick’ when a resident planned activity has taken place, with only occasional comments from staff recorded. The manager should ensure that this recording is further developed to include comprehensive positive comments about the residents’ participation in each of his or her preferred activities, and to link this with the individual resident’s care plan. This was discussed with the registered manager. People using the service were observed to participate in some activities during the inspection. These included a resident doing a ‘word search’ puzzle, another resident was supported with knitting on a one to one basis with staff, and another resident did some drawing. Other residents watched television. Though there has been some development in the provision of a variety of activities, there could be continued development (with full involvement and participation of all staff including care staff) in the provision of preferred activities for people using the service as recommended during the previous key inspection in 2006. There is a person employed who drives the passenger vehicle and accompanies people using the service on day trips. He spoke positively of resident’s recent day trips, which included a trip to Bournemouth during the week prior to the inspection and of other day trips to Oxford, and Windsor. A visitor reported (prior to the inspection) that these trips were much enjoyed by his/her relative. The manager spoke of having applied for each resident to have a ‘taxi card’ to enable them to access local taxis at an economical fee. The manager spoke of one reason for getting taxi cards for residents was due to there having been occasions when people using the service have been unable to access their day resource centres when the passenger vehicle has not been accessible. The registered person should make sure that there are systems in place to ensure that people using the service can access their regular day resource centres at all times. People who use the service have the opportunity to develop and maintain personal and family relationships. The registered person does not impose restrictions on visits (unless requested by the resident concerned). A resident spoke of the visitors that they received on a regular basis. A relative of a resident who kindly spoke with the inspector prior to the inspection, reported that he/she visited the care home regularly and confirmed that the atmosphere was welcoming. The visitor’s record book indicated that people regularly visited the home. Due to the communication needs of most residents they were unable to say if they had contact including visits from family and friends, but staff were knowledgeable of the contact that people living in the home had Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 15 with them. A resident spoke of ‘seeing’ friends at day resource centre. I was informed that a person using the service has an advocate. The home has a menu which recorded varied and wholesome meals. Since the last key inspection photographs of the meals of the day are now displayed with the written menu. This is positive. A resident spoke of enjoying the meals provided. This included the lunch provided during the inspection. The lunch during the inspection was unhurried. Staff were observed to encourage residents with their meal and to provide assistance when needed. Staff were not observed to communicate much nor obviously explain to those residents (that they assisted with lunch) in detail what they were having for lunch. This was discussed with the manager. He confirmed that he would ensure staff received further training in regard to assisting people using the service with their meals. Some dietary needs and preferences are recorded in the care plan, but this could be further developed. The cook was knowledgeable of the particular dietary needs of the people living in the care home. She confirmed that the home receives regular deliveries of quality meat and fresh vegetables, and gave examples of how she ensured that all the residents had access to fruit on a daily basis, which could include being part of a meal such as in a fruit salad. There should be systems in place to ensure that residents and staff regularly have the opportunity to purchase fresh fruit and vegetables in between the weekly deliveries. The cook and the manager confirmed that this would be actioned following the inspection. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the care home can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances. The format of these policies could be more accessible to people using the service. EVIDENCE: The care home has a complaints policy. This is in written format, and recorded in the service user guide documentation. The registered person should develop the format of the complaints procedure to ensure that it is accessible as possible to the people using the service. The registered person should develop ways to ensure that service users and/or relatives /significant others are supported and encouraged to communicate ‘concerns’ as well as complaints, and that these be documented and appropriate action taken. This was discussed with the registered manager. There were no complaints recorded though the manager spoke of a relative who had communicated some ‘concerns’ which the staff had ensured were resolved. All Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 17 ‘concerns’/complaints, and the action taken to resolve them needs to be documented. The home has a protection of vulnerable adults policy. Staff who spoke with the inspector were knowledgeable of the reporting and recording procedures in regard to an allegation or suspicion of abuse. A Local Authority safeguarding adult’s procedure was displayed. The registered person should access the up to date Local Authority Safeguarding Adults policy/procedure. Records and staff confirmed that staff had received protection of vulnerable adults training. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,23 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. Residents’ bedrooms are individually personalised, and meet their individual needs. EVIDENCE: Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 19 The care home is located close to Stanmore, which has a variety of shops, restaurants, banks and other amenities. Bus public transport facilities are accessible within a few minutes walk from the home. Train tube stations are located within a few minutes drive from the care home. The front of the care home is tidy and attractive. There is parking for several cars at the front of the property. There has been some redecoration of some of the communal areas and new carpet in the communal passageways. There are several areas were the paintwork (particularly in the communal areas) is chipped and/or damaged due to wear and tear and could be repainted. The manager reported that there is an on going programme of redecoration taking place, which includes resident’s bedrooms. The sitting room/dining room area has homely features. Pictures and photographs of residents are displayed. Residents moved freely within the communal areas of the home. Bedrooms are generally personalised. Pictures, photographs and ornaments were among the items located in resident’s rooms. The manager spoke of residents being able to use their own furniture if they wish. Some bedroom armchairs could be replaced due to them being ‘old fashioned’ and of an ‘institutionalised’ type. Two residents spoke of being happy with their bedrooms. The call bells in the home are in working order. One bedroom had another resident’s wheelchair in it. This was removed following discussion with staff. Wheelchairs not belonging to the resident should not be stored in their bedroom. The home is clean and odour free. Soap and paper hand towels were located in the bathrooms/toilets inspected. An upstairs toilet facility did not have accessible toilet paper. The manager spoke of it not being displayed due to the ‘challenging’ behaviour of a resident. The registered person should seek out a facility that ensures that toilet paper is accessible to all, and meet the needs of those that might challenge the service. The home has an infection control policy/procedure. Since the last key inspection the care home has issued all staff with bottles of alcohol hand cleanser. The manager confirmed that the use of which is monitored by senior staff. The laundry facilities are located away from food storage and food preparation areas. The home has recently installed a new industrial washing machine and new clothes dryer. A domestic staff member undertakes cleaning duties. Records confirmed that some staff had completed infection control training. Staff were observed to wear protective clothing as and when needed. Disposable gloves were seen to be accessible to staff. Minutes of a staff meeting confirmed that the manager had spoken to staff about the importance of wearing disposable gloves and of changing them. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities in caring for the people living in the home.. Arrangements are in place to ensure that people living in the home are supported and protected by the care home’s recruitment policy and procedures. EVIDENCE: Most of the trained nursing staff and the care staff have worked in the care home for sometime. A resident spoke of the staff being ‘caring’ and ‘kind’. Most people using the service, due to their communication needs are unable to communicate their views of the staff so observation, and inspection of records Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 21 were significant tools used in regards to gaining an assessment of the service provided to residents by staff. Prior to the inspection, a visitor had confirmed that he/she has confidence in the staff team, and that staff were skilled in their role and were understanding of the needs of his/her relative. The staff rota was available for inspection. The registered manager spoke of staffing numbers being flexible in regards to ensuring that the needs, and the changing needs of people using the service are met. The staffing levels were judged to reflect the needs of the people using the service. Though staff worked some ‘long’ shifts, records confirmed that they were not working excessive hours during the week. Staff were observed to interact with people using the service in a respectful and sensitive manner. Staff who spoke with me were judged to have a good understanding of the needs of the residents and of how to meet those varied needs. The registered manager reported that four staff are in the process of completing NVQ (National Vocational Qualification) level 2 care course, and that three care staff have achieved the qualification. This, I was informed culminated in 66 of staff having achieved or are in the process of achieving NVQ care courses. The Organisation employs an in service trainer, and outside trainers support care staff to achieve NVQ qualifications. The home has a staff training plan. There was evidence that the service ensures all staff receive relevant training that is focused on delivering improved outcomes for people using the service. Records confirmed that staff had undertaken statutory training, and other training appropriate to their role and responsibilities. Records and staff confirmed that training included first aid, moving and handling, and food and hygiene training, health and safety training, fire safety training, managing ‘challenging’ behaviour, and nutritional training. I was informed that all staff had recently received moving and handling training. It is recommended that all staff receive training in regard to ‘Person Centred Planning’ (see National Minimum Standard 7). The home has a recruitment and selection policy/procedure, and an equal opportunities policy. Three staff personnel files were inspected. This documentation included evidence that required and appropriate recruitment procedures had been carried out including obtaining enhanced Criminal Record Bureau checks (a check in regard finding out whether a person has ever committed a crime). Records and staff confirmed that staff meetings take place regularly. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the care home, and staff are appropriately supervised. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 23 Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of people using the service and staff is promoted and protected. EVIDENCE: The registered manager/provider has managed the care home for several years. He is a registered nurse and is experienced and knowledgeable in regard to meeting the care and support needs of the people using the service. He has achieved the Registered Manager’s Award qualification. He has worked with adults with a learning disability for a significant number of years, and it was evident that he knows the residents well and aims to provide them with a quality service. There are clear lines of accountability within the home and with external management. The manager confirmed that he receives regular supervision from his line manager. The manager reported that he is due to retire from his position as manager of the care home, at the end of this year. There was evidence that there were procedures in place to monitor the quality of the service provided to service users. The manager carries out a monthly audit of these systems, which includes the monitoring of staff training, pressure area care, cleaning, medication, staff records, water temperature monitoring, and risk assessments. The operations manager also audits the quality of the service during unannounced visits to the care home as required. The manager spoke of questionnaires having been sent this year to relatives/significant others to gain their views of the service, but had yet had any returned. The registered person should supply questionnaires to other stakeholders, such as people using the service, Care Managers, community nurses, GPs and others who have regular contact with the home. Regular maintenance checks take place. The service has up to date sound policies and procedures. The manager spoke of the systems in place to monitor staff adherence to policies and procedures. The home has received a recent inspection from an Environmental Health Officer. The registered manager reported that requirements and recommendations from this visit had been completed by the home. Records and staff confirmed that staff receive regular 1-1 staff supervision in which they receive feedback about their work and examine staff roles in meeting the individual needs of people using the service. The home has a service user finance policy/procedure. Resident’s monies are managed by relatives or by the Court of Protection. The manager reported that the care home manages only small amounts of resident’s spending Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 24 money. Three residents monies were inspected. Records and procedures for managing resident’s monies have improved since the last key inspection, but there is a need for further improvement. Several receipts inspected were for several residents items i.e. toiletries and meals out, and though the residents who had bought these items were identified it was not always clear exactly which item had been bought by which person using the service. Also a receipt recorded that two residents had paid for a care staff’s ticket to a leisure event, which was attended by residents and staff. There was no recorded evidence in neither the statement of purpose nor in the resident’s terms and conditions of this policy/procedure. The operations manager reported that this was not organisational policy. These residents need to be paid back money that they are owed, and that appropriate financial procedures are followed and monitored closely. The manager spoke of ensuring that the two residents concerned would be reimbursed. The home has a clear health and safety policy, and staff are trained to ensure that they are aware of the policy and have an understanding of putting health and safety procedures in to practice. Records confirmed that regular maintenance checks of the environment are carried out. The registered manager reported that the specialist bath and the moving and handling hoist had been serviced the day before the inspection. The home has some general health and safety risk assessments in place, and regular health and safety checks are carried out. There needs to be recorded evidence that a required electrical installation check has been carried out. Fridge/freezer and water temperatures are monitored. Required fire safety checks and drills are carried out. The home has an up to date fire risk assessment. Though doors were not observed to be wedged open during the inspection, there were several door wedges located close to several doors including bedrooms. If doors need to be left open during the day, advice from the local fire service should be sought in regard to appropriate mechanisms for enabling doors in the home to be left open during the day, and the fire risk assessment be appropriately reviewed. The home has an accident policy/procedure. Accidents are recorded as required. The care home has an up to date employers liability insurance certificate. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 3 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 3 35 2 36 3 37 X 38 3 Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 (1)(2) • Requirement There needs to be more evidence that resident’s recorded goals/objectives (short term and long term) are reviewed and evaluated regularly, • and that risk assessments including guidance to minimise risk are further developed. There needs to be evidence that appropriate risk assessments of the use of bedrails have been carried out (with the resident, family significant other i.e. health and/or social care professional) in regard to their safety. People using the service must have access to all medication prescribed to them, and appropriate prompt action by the registered person needs to take place if a resident ‘runs out’ of medication. The date of opening of eye drops bottles needs to be recorded. • All receipts of expenditure by residents need to clearly state which item DS0000022927.V344015.R01.S.doc Timescale for action 01/12/07 2 OP8 12 13(4) 01/11/07 3 OP9 13(2) 01/10/07 4 5 OP9 OP35 13(2) 13(6) 01/10/07 01/10/07 Holly Bush Nursing Home Version 5.2 Page 27 5 OP38 23(2) was purchased by each resident. • It needs to be clearly documented in the resident’s statement of terms and conditions if residents pay for staff tickets on residents outings, and if this is not the policy, the resident’s concerned need to be reimbursed. There needs to be recorded evidence that a required electrical installation check has been carried out. 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP3 OP7 Good Practice Recommendations The registered person should develop ways of improving the format of the service user guide to increase its accessibility to the residents. The registered manager should ensure that assessment information from the relevant funding Local Authority is obtained and documented in the residents care plans. There should be further development in the process of ensuring that service users and/or their relatives/significant others are supported in participating as fully as they are able in the development of service users’ care plans. The registered manager should be examining ways to develop care plans that include a ‘person centred’ approach. • The manager should ensure that recording is further developed to include comments about the resident’s participation in each of his or her preferred activities. • The registered person should make sure that there are systems in place to ensure that people using the service can access their regular day resource centres at all times. DS0000022927.V344015.R01.S.doc Version 5.2 Page 28 4 OP12 Holly Bush Nursing Home 5 OP15 6 OP16 7 8 9 10 11 OP18 OP26 OP30 OP33 OP38 The variety of activities (particularly ‘in house’) for people using the service could be further developed. • There should be systems in place to ensure that residents and staff have the opportunity to purchase fresh fruit and vegetables in between the weekly deliveries. • The manager should ensure staff received further training in regard to assisting people using the service with their meals. • The registered person should develop ways to ensure that service users and/or relatives /significant others are supported and encouraged to communicate ‘concerns’ as well as complaints, and that these be documented and appropriate action taken. • The format of the complaints policy (and others particularly relevant to people using the service) could be improved. The registered person should obtain a copy of the up to date Local Authority Safeguarding Adults policy/procedure. The registered person should seek out a facility that ensures that toilet paper is accessible to all, and meet the needs of those that might challenge the service. It is recommended that all staff receive training in regard to ‘Person Centred Planning’ (see National Minimum Standard 7). The registered person should supply all stakeholders and service users with questionnaires, in regard to their views of the service provided by the home. The registered person should record evidence of having reviewed accidents/incidents on a monthly basis. • Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. Extracts may not be used or reproduced without the express permission of CSCI. Holly Bush Nursing Home DS0000022927.V344015.R01.S.doc Version 5.2 Page 30 - 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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