Inspection on 20/06/06 for Holly Bush Nursing Home

This inspection was carried out on 20th June 2006.

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

Holly Bush Nursing Home 14/08/07

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 20th June 2006 08:40 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.V300812.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.V300812.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 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.V300812.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. 8th November 2005 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. 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, and the 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.V300812.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 June 2006. The inspector was pleased to speak to seven of the eight residents during the inspection. Verbal communication with the residents was varied due to their disability needs, so observation was an important tool used in the inspection process. The care home had four vacancies at the time of the inspection. The purpose of the inspection was to spend time with the service users, assess key standards, and to follow up and assess as to whether requirements and the 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 observing interaction between residents and staff. No feedback/comment cards from relatives/visitors, healthcare professionals or pre inspection information/documentation were received by the Commission for Social Care Inspection. The inspector supplied the manager with another copy of the pre- inspection questionnaire documentation. The registered manager was present during most of the inspection. Staff kindly provided all the information, and documentation requested by the inspector during the inspection. Key National Minimum Standards and one other Standard were assessed during the inspection and the requirements from the previous inspection were judged as having been met. What the service does well: The care home has a welcoming and calm atmosphere. The home is clean and well maintained. Staff receive varied and appropriate training to ensure that they have the knowledge and skills to meet service users varied and often needs. Staff are respectful and sensitive in regard to meeting service users needs. During the year service users have the opportunity to participate in several day trips to places of interest. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 6 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. Holly Bush Nursing Home DS0000022927.V300812.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.V300812.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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents have their needs assessed prior to moving into the care home, but there needs to be evidence of some further development in regard to the assessment process. EVIDENCE: The care home has an admission procedure. This generally involves a referral from a Care Manager. The registered manager reported that he and the deputy manager then assess the prospective resident. There had been two new admissions to the care home since the previous inspection. The care plans of these two residents both included recorded initial comprehensive assessment information completed by the registered manager. These Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 9 assessments incorporated information in regard to the service user’s individual health, personal care, social and welfare needs. It was evident that that from this assessment a care plan recording some of the resident’s needs and staff action to meet those assessed needs had been developed. There needs to be evidence that there has been appropriate consultation regarding the assessment with the service user or a representative of the service user. These two care plans did not contain up to date assessment information/documentation from the Care Manager of the purchasing placing Authority. There was some brief assessment information in regard to one service user that had been completed by a community nurse, but this was not signed nor dated and is was evident from the documentation and information that this was not recent assessment information. This was discussed with the registered manager, who confirmed that this had been the only information provided by the placing Authority. The registered person should ensure that an up to date initial assessment from the placing Authority is accessible in the service users’ care plan. Holly Bush Nursing Home DS0000022927.V300812.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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7,8,9 and 10 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s health social and personal care needs are set out in an individual care plan, but the care plans need further development to ensure that all service users assessed needs are met. Medication is stored and administered to residents safely, but there needs to be review some of the medication systems. Arrangements are in place to ensure that the residents are respected and their right to privacy upheld. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 11 EVIDENCE: All the service users have a recorded plan of care and support. Four care plans were inspected. These included care plans of two recent admissions to the home. The care plans included information in regard to assessment of the physical health needs, mental health needs, personal care needs, mobility needs, nutritional needs and risk assessment of falls, behaviour, manual handling and pressure care needs. There was recorded evidence of some staff guidance to meet assessed needs, which was clear and informative. Some guidance in the care plans inspected needs to be further developed in regard to risked assessed/and assessed needs. Particularly when the score from the assessment is high risk or medium risk, such as assessed road safety needs of a service user. Some staff guidance i.e. for meeting specialist medical needs (such as service users’ diabetic and also epilepsy needs, particular monitoring of the nutrition/dietary needs and weight of a service user, who has had a serious medical condition, and a service user’s skin condition), also needs to be further developed to ensure that staff have knowledge of the appropriate action to be taken to meet those assessed needs. Staff need to ensure that identified needs such as when a service user regularly refuses meals, and if a service user needs assisted feeding are assessed and that there is recorded staff guidance to meet those needs in the care plan. There needs to be evidence that the care plan is drawn up with each service user (if able) and relatives and /or significant others. This was discussed with the registered manager. Care plans recorded evidence of having been regularly reviewed by staff in the care home, but records confirming the funding authority involvement in the review of service users needs (including their challenging behaviour needs) was not evident in the care plan. There should be recorded evidence that the funding authority participates in the review of residents needs, particularly in regard to recently admitted service users and when service users challenge the service. All service users have a key worker. ‘Daily’ service users’ progress records are maintained. Records and staff confirmed that service users’ health needs are identified and that service users have access to healthcare specialists, including community nurses, a Macmillan nurse, chiropodist, optician checks, and visits by doctors. There needs to be evidence that service users have the opportunity to receive dental ‘check ups’ and treatment. All service users are registered with a GP. The medication storage and administration systems were inspected. Medication is stored securely. The registered nurse on duty confirmed that the trained nurses administer the medication. There were several gaps in the Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 12 recording of medication administered. The nurse in charge spoke of a resident not having received a prescribed dose of analgesia on the morning of the inspection due to ‘issues’/problems in regard to obtaining prescriptions. The medication administration record sheets recorded that some medication had at times been omitted, but there was no record as to why the medication was not given, and whether the GP had been informed of this. The registered person needs to ensure that medication is reviewed regularly by the GP to ensure that if it not needed by a service user that it is no longer prescribed. The medication fridge thermometer located inside the fridge was displaying a high temperature, whilst the electrical fridge thermometer located beside the medication fridge was recording a satisfactory temperature. It was evident during the inspection that service users are treated with respect. Staff were observed to respect service users’ privacy during the inspection. The registered manager confirmed that staff are informed during their induction programme of the importance of respect towards service users Holly Bush Nursing Home DS0000022927.V300812.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13,14,15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to enable residents to participate in activities of their choice, and to maintain contact with family/significant others, as they wish. Meals are varied and wholesome. EVIDENCE: Service users were observed to participate in some activities during the inspection. These included watching television, doing word puzzles, and jigsaw puzzles. Several service users participated in a drawing /art activity session Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 14 arranged by activity workers who visit the care home on a weekly basis. One service user attended a day centre. Staff and records confirmed that residents had had the opportunity to participate in a variety of day trips, which included a recent visit to Oxford. Staff confirmed that there was another day trip planned on a day during the week of the unannounced inspection. The care home has access to a passenger vehicle and employs a driver. There were some recorded individual activity plans for some service users but no record seen for the service users recently admitted to the care home. Activities participated in by service users were not regularly recorded. The registered manager should ensure that activities in which service users are involved in are clearly documented and kept up to date. Records and feedback from a relative confirmed that the home has visitors. Staff informed the inspector of the varied contact that service users have with relatives/significant others. A service user kindly showed the inspector some photographs of her family. Some service users had photographs of family members in their bedroom. The registered manager reported that relatives/significant others can visit at any time. Evidence of contact with relatives/visitors was recorded in the staff communication book and visitor’s record book. Service users were enabled to make a number of choices during the inspection. The care plans inspected documented service users preferences. Staff who kindly spoke with the inspector had knowledge and understanding of service users ‘likes’ and ‘dislikes’, and explained how they got to know service users needs when a service user has communication needs and few verbal skills. Bedrooms that were inspected confirmed that service users are entitled to bring personal possessions with them into the care home. The menu was available for inspection and the meal provided during the inspection corresponded appropriately with the menu. Since the last inspection staff have developed the accessibility of the menu. Photographs of the meals provided on the day of the inspection were displayed on a notice board in the sitting/ dining room. This is positive. The meal provided during the inspection was judged to be wholesome and nutritious. Service users appeared to enjoy the meal and a resident with verbal skills confirmed that she had liked the meal. (See standard 7 in regard to guidance needed for when a service user refuses meals and for when a service user needs assistance with feeding.). The lunch provided during the inspection was unhurried. The cook who spoke with the inspector had a good knowledge and understanding of the particular dietary needs of service users. Food eaten by service users is documented. The kitchen should be accessible to service users (following risk assessment) to enable them, with staff support to make drinks and snacks if they wish. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16, 18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that complaints are dealt with promptly and effectively, and that residents are protected from abuse. EVIDENCE: The care home has a complaints procedure, which was displayed in the care home. There were no complaints recorded. 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 home has a protection of vulnerable adults policy which links to the Local Authority procedure/guidance. Records confirmed that staff had received protection of vulnerable adults training in September 2005. The registered manager reported that staff receive information in regard to abuse awareness in their induction programme. Staff who spoke to the inspector were aware of recording and reporting procedures in regard to response to suspicion or allegation of abuse. The care home has a whistle blowing policy and procedures in regard to service user’s money and financial affairs. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19, 23 26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The location and layout of the care home is suited for its stated purpose, and is generally well maintained, and very clean. EVIDENCE: The home is located within a few minutes drive from Stanmore and Harrow. It has parking for several cars on the forecourt of the home. A tour of the premises took place during the inspection. There is a maintained enclosed garden. The manager reported that the summer garden furniture was stored Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 17 in a garden shed. This garden furniture should be accessible in the garden throughout the summer months. Some old items of furniture etc should be removed from the garden. The home is generally well maintained. The registered manager reported that a ramp had recently been built on the first floor of the care home to enable access for wheelchair user. The kitchen has recently had new worktops and a new microwave and dishwasher fitted. The damaged fly screen in the kitchen needs replacing. A resident kindly showed the inspector her bedroom. Resident’s rooms are individual personalised. The care home employs a domestic staff member. The home was clean and odour free at the time of the inspection. The laundry facilities are located away from food storage and food preparation areas. The home has recently installed a new industrial washing machine and dryer. Hand washing facilities are prominently sited throughout the care home. The extractor fan in the shower room needs cleaning. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28,29, and 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that staffing numbers and skill mix meet the needs of the residents, and that residents are protected by the care homes’ recruitment and selection procedures. Staff receive appropriate training to ensure that they have the skills and competency to meet the needs of residents. EVIDENCE: The staff rota was available for inspection. There is a qualified trained nurse on duty at all times. The registered manager spoke of having recently employed a fulltime permanent registered nurse. The staff numbers on duty met the condition of registration. There were four care staff and a registered nurse on duty plus the registered manager. One service user was receiving 1:1 care and support from staff during the inspection to meet their assessed needs. The registered manager confirmed that additional staff are provided to meet changing needs of residents and to enable certain activities to take place. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 19 The care home also employs a domestic staff member and a cook. The registered manager reported that staff meetings take place on a two monthly basis. A` staff ‘handover’ took place during the inspection. The registered manager confirmed that four staff had completed NVQ level 2 in care, and that one staff member was in the process of completing the course, and that one staff member had themselves made arrangements to do the NVQ level 3 care course, and that other staff would be commencing NVQ care courses in the future. The registered person should ensure that all care staff have the opportunity to complete NVQ level 2 in care training courses. The care home has a recruitment and selection procedure. Four staff personnel files were inspected. These included required information and documentation including enhanced Criminal Record Bureau checks. The registered manager confirmed that all staff are supplied with a copy of the General Social Care Council code of conduct, and receive terms and conditions of employment. Staff and records confirmed that staff received varied training to ensure that they can meet the needs and changing needs of service users. This training includes a comprehensive staff induction. The registered manager should ensure that all staff have evidence of having completed a recorded induction programme. Other recorded training included fire safety training, health and safety training, infection control training and manual handling training. Records confirmed that several staff had completed Control of Substances Hazardous to Health (COSHH) training, and Reporting of Diseases and Dangerous Occurrences Regulations (RIDDOR) training. A staff training plan for 2006-2007 was available for inspection. The inspector was informed that First Aid training, wound and pressure care training were planned. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31,33,35,38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The resident’s benefit from an experienced and competent management approach to the care home. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 21 Arrangements are in place to ensure that the service provided by the care home is monitored and improved as necessary to meet the aims and objectives of the home. Resident’s financial interests are safeguarded, and the health, safety and welfare of residents and staff are promoted and protected, but some development of health and safety documentation, and review of reporting procedures needs to take place. EVIDENCE: The registered manager is a qualified nurse. The inspector was informed that the registered manager has recently completed the Registered Managers Award. He has worked with adults with a learning disability for several years. There are clear lines of accountability within the home and with external management, and the manager confirmed that he receives regular supervision with his line manager. The manager works varied shifts and he reported that he regularly ensures that he visits the care home at night to ensure that there is appropriate communication with night staff. There was evidence that there were procedures in place to monitor the quality of the service provided to service users. This includes evidence of reviewing service users’ care plans, and other documentation. 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. Regular maintenance checks take place. The Commission for Social Care Inspection. received no feedback/comment cards from relatives/visitors and from healthcare professionals. This was discussed with the manager, who spoke of plans to supply visitors and service users with questionnaires, about their views of the service provided by the home. This should be actioned by the registered manager. Required visits by a representative of the provider take place and the Commission for Social Care Inspection is regularly supplied with copies of this documentation. The care home has an accident reporting procedure. There were a number of incidents recorded in a resident’s behaviour observation chart, which concerned the safety and well being of other residents and of staff. These were not recorded on the appropriate accident record documentation, nor reported to the Commission for Social Care Inspection. The registered manager needs to ensure that the systems for recording and reporting incidents/accidents are reviewed and that staff are all aware of the accident reporting/recording procedure. The Commission for Social Care inspection needs to be informed of incidents that are notifiable, including any event in the care home, which adversely affects the well-being or safety of any service user. The registered person should record evidence of having reviewed accidents/incidents on a monthly basis. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 22 Service users are unable to manage their monies/finances without support. The registered manager manages two service users’ monies/finances. He reported that he would not be acting as an agent in regard to the monies of future admissions to the care home. Generally monies are managed by relatives/significant others, so that only spending money from service users personal allowances are managed by the home. Records of transactions and balances were available for inspection. These records have improved since the last inspection, and monies checked had the correct balance. The system of ‘corporate’ receipts needs to cease. Service users need to be supported and enabled to buy individual toiletry items with their own money, and therefore have their own receipts. A service user recently admitted to the care home needs to have access to their finances and be supported to access their entitled personal allowances. The registered manager should seek advice in regard to this from the Care Manager. All service users need to have a recorded individual financial assessment to ensure that they are receiving all their allowances and that their finances are managed appropriately. Certificates of worthiness in regard to safety checks of the gas and electrical systems in the care home were available for inspection and were up to date. The fridge/freezer temperatures are monitored daily. The care home needs to ensure that general health and safety risk assessments are completed in regard to staff safe working practices, which might include practices such as carrying shopping, bathing service users, and pushing wheelchairs. Required fire checks and fire drills are carried out. The care home has a fire risk assessment it was dated 2002. This needs to record evidence of having been reviewed. The employer’s liability insurance certificate was displayed and up to date. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 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 X 35 2 36 X 37 X 38 2 Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 24 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)(c) Requirement Timescale for action 01/10/06 2 OP7 3 OP7 There needs to be evidence that there has been appropriate consultation with the prospective service user (if able) or their representative regarding the initial assessment of the prospective service user’s needs. 15 (1) There needs to be evidence that 01/10/06 the service user care plan is drawn up (and reviewed) with each service user (if able) and relatives and /or significant others participation. 12,1314,15 • Some staff guidance for 01/10/06 meeting service users assessed needs, needs to be further developed. • Staff need to ensure that all service users’ identified needs are assessed and that there is appropriate recorded staff guidance to meet these needs. 12,13 There needs to be evidence that service users have the opportunity to receive dental ‘check ups’ and treatment. • The registered person DS0000022927.V300812.R01.S.doc 4 OP8 01/10/06 5 OP9 13(2)(4) 01/08/06 Page 25 Holly Bush Nursing Home Version 5.2 6 OP19 23 7 OP35 13(6) 8 OP35 13(6) 14 9 OP38 12,13(4) needs to ensure that service users receive their prescribed medication. • If a prescribed dosage of medication is omitted there needs to be a record of the reason for this and there needs to be evidence that the GP has been informed and so review the medication. • Staff must ensure that they always record when medication is administered. • The medication fridge thermometers need checking to ensure that they are recording the correct temperature, and replaced if they are not. • The damaged fly screen in the kitchen needs replacing. • The extractor fan in the shower room needs cleaning. The system of ‘corporate’ receipts in regard to the purchase of service user’s toiletries needs to cease. • A service user recently admitted to the care home needs to have access to their finances and be supported in accessing their entitled personal allowances. • All service users need to have a recorded individual financial assessment to ensure that they are receiving all their allowances and that their finances are managed appropriately. • The registered manager DS0000022927.V300812.R01.S.doc 01/09/06 01/09/06 01/10/06 01/09/06 Page 26 Holly Bush Nursing Home Version 5.2 37 (1)(e) 10 OP38 12,13 18 11 OP38 12,13 needs to ensure that the systems for recording and reporting incidents/accidents are reviewed • and that staff are all aware of the accident reporting/recording procedure, • and that the Commission for Social Care inspection is informed of notifiable incidents. The care home needs to ensure that general health and safety risk assessments are completed in regard to staff (and service users if applicable) safe working practices, which might include practices such as carrying shopping, bathing service users, and pushing wheelchairs. The fire risk assessment (dated 2002) needs to record evidence of having been reviewed. 01/10/06 01/10/06 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 Refer to Standard OP3 OP7 Good Practice Recommendations The registered person should ensure that an up to date initial assessment from the placing Authority is accessible in the service users’ care plan. There should be recorded evidence that the funding authority participates in the review of residents needs, particularly in regard to recently admitted service users and when service users challenge the service. • The registered manager should ensure that activities in which service users are involved are clearly documented and kept up to date. DS0000022927.V300812.R01.S.doc Version 5.2 Page 27 3 OP12 Holly Bush Nursing Home 4 5 OP15 OP16 6 OP19 7 8 9 10 OP28 OP30 OP33 OP35 11 12 OP38 OP38 • Each service user should have an activity plan. The kitchen should be accessible to service users who have received risk assessment, so that they can be supported in making drinks and snacks if they wish. 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 garden furniture should be accessible in the garden throughout the summer months. • Some old items of furniture etc should be removed from the garden. The registered person should ensure that all care staff have the opportunity to complete NVQ level 2 in care training courses. The registered manager should ensure that all staff have evidence of having completed the new induction format. The registered person should supply visitors and service users with questionnaires, in regard to their views of the service provided by the home. The registered manager should seek advice from the Care Manager in regard to the management of a service user’s finances, and to ensure that the service user is receiving their personal allowances. The registered manager should record the names of staff and service users who participate in fire drills. The registered person should record evidence of having reviewed accidents/incidents on a monthly basis. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. Holly Bush Nursing Home DS0000022927.V300812.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!