Inspection on 02/06/08 for Holly Lodge Nursing Home

This inspection was carried out on 2nd June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Holly Lodge Nursing Home St Catherines Road Frimley Green Surrey GU16 9NP Lead Inspector Suzanne Magnier Unannounced Inspection 08:00 2nd June 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holly Lodge Nursing Home Address St Catherines Road Frimley Green Surrey GU16 9NP 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) 01252 833080 01253 833081 veronica.watson@forestcare.co.uk Forest Care Ltd Miss Veronica Venora Anester Watson Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) The maximum number of service users to be accommodated is 60. 2. Date of last inspection Not applicable Brief Description of the Service: Holly Lodge is a purpose built nursing and residential home designed to provide nursing care and accommodation to individuals with levels of confusion, mainly with a diagnosis of Alzheimers, and other dementia related conditions. The home is set in its own landscaped gardens, on the outskirts of Frimley Green, and is surrounded by woodland, which creates an atmosphere of peace and tranquillity. The home is privately owned and managed by Forest Care Ltd. The home has been designed over two floors and each floor has a large dining/lounge area with comfortable furnishings including dining tables/chairs and armchairs set in small clusters. There are a variety of rooms available for residents to use which include a well equipped activities room with its own built in sensory room, a family room where residents can meet with their friends and family in private, a doctor’s room for private consultations, a kitchen to prepare snacks and maintain daily living skills, and a hairdressing saloon. Resident’s bedrooms all include en-suite facilities and a call bell system. Residents are encouraged to bring small items of furniture and personal effects in order to help them to feel at home. There are a variety of signs to assist residents when they are moving around the home to orientate themselves and handrails to assist residents with their mobility. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 5 The bathrooms and toilets provide specialist equipment to assist resident’s comfort, independence and safety and the home has a shaft lift which accessible to all residents in the home. Residents are able to access the enclosed sensory garden and there is ample car parking facilities available. The home has a registered manager, operations manager and a general nurse in charge of the clinical aspects of the care home. The fees for the service range from £900.00 to £1,000 .00 per week. There is an additional cost for hairdressing, chiropody and dry cleaning. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The Commission for Social Care Inspection, (CSCI) has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was the first since the home was granted registration by the commission and opened in January 2008. It was acknowledged throughout the inspection that as a new service some areas of the home required further development and the homes owner, manager and Head of Care demonstrated a commitment to the ongoing development of the home in order to promote and ensure the well being, quality of life and safety of residents at the home. The inspector looked at and assessed how well the service was meeting all the National Minimum Standards for Care Homes for Older People set by the government and has in this report made judgements about the standard of the service. Ms S Magnier Regulation Inspector carried out the inspection, which lasted for ten hours and fifteen minutes; commencing at 08.00hours and concluded at 18.15. The registered manager represented the service with the inclusion of one of the owners, Director of Care and the nurse in charge. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CSCI and is referred to throughout the report. Eleven residents currently receive care and support at the home and as part of the inspection process the pre admission assessment procedures were discussed to ensure that people admitted to the home are assured that the homes staff can meet their needs. The majority of the residents spoken with were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of residents, their relatives who were visiting, care staff, including the chef and from information contained within the AQAA. Further information was gathered from records kept at the home and written comments received from residents. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 7 The home are actively recruiting more staff to compliment the existing staff team which comprises of the registered manager who is a registered general nurse, an operations manager who is also the homes responsible individual, several registered general nurses and registered mental nurses, care assistants, bank staff, a qualified chef and assistant, activities co-ordinators, a handy person and housekeeping staff. A full tour of the premises was undertaken and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, care plans, life story plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records, and the homes policies and procedures. The final part of the inspection was spent giving feedback to registered manager, one of the owners, Director of Care and the nurse in charge about the findings of the visit. The commission have not received or been made aware of any notifications of complaints or safeguarding vulnerable adults referrals since the home was granted registration. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of clients who have diverse religious, racial or cultural needs. What the service does well: The home ensures that pre- admission assessments are carried out on all new and potential residents with only those whose needs can be met, being admitted to the home. People are offered a good provision of health care and personal support by the home. Care is generally administered in way that protects the individual’s privacy and dignity and the general monitoring of risk assessments is maintained to ensure the safety of people in the home. People are able to make choices about their daily routines and enjoy and choose from a range of activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members. The home provides a healthy and balanced diet in a pleasant spacious dining area. The residents are protected by the homes complaints and safeguarding adults procedures and peoples legal rights are protected. The physical layout and indoor and outdoor communal of the home enable people who use the service to live in a safe and well-maintained environment. Individual’s independence is promoted and maximised using specialist equipment. Individual’s bedrooms suit their needs and the communal bathrooms and toilets are adequate in number. All areas of the home are clean and hygienic. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 8 Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home has a robust system for the induction, and training development to ensure peoples needs are met appropriately and safely. The management of the home is robust to ensure the safety and wellbeing of residents. Residents are consulted regarding the running of the home and their health and financial interests are safeguarded. The health and safety of all persons in the home is promoted and robust policies and procedures are in place. 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 Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Well-written information regarding the services provided by the home is available and opportunities of visits to the home for prospective residents and their representatives in order that they can make an informed choice about moving to the home are arranged. The admission and assessment procedures ensure that resident’s needs are appropriately identified and met. Residents or their representatives have a written contract regarding the terms and conditions of residency. Intermediate care is not currently offered. EVIDENCE: The homes brochure, Statement of Purpose, Service User Guide and resident handbook were well documented to inform prospective residents and their representatives about what the home offers, the management and staffing structures of the home, the accommodation and services available, the staff Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 11 members level of training and how people could complain if they were unhappy with the service provided. The AQAA completed by the home identified improvements within the documents, which include adding the comments and experiences of residents living at the home within the information and providing the documents in larger print and audio tape for prospective residents with sensory impairments in order that they have a more informed choice about moving into the home. The manager explained, and it was observed, that residents have a contract, which describes the arrangements for payments of fees and what the costs are for regarding the care and accommodation provided at the home including any additional fees. Four resident’s care plans were sampled during the inspection and all contained information to confirm that the individuals needs had been assessed by a member of staff with the ability and qualifications to undertake the assessment prior to the persons admission to the home in order to ensure that the homes staff could meet the individuals care and support needs. Visitors to the home confirmed that they and prospective residents had been offered the opportunity to visit the home prior to admission. A trial period, which includes the ongoing assessment of the residents needs is arranged following admission to the home and every effort is made to help the resident feel settled in their new environment and feel included in their admission to the home. No intermediate care is currently offered by the home. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People are offered a good provision of health care and personal support by the home. Care is generally administered in way that protects the individual’s privacy and dignity and the general monitoring of risk assessments is maintained to ensure the safety of people in the home. Some areas of care planning and medication procedures need to be strengthened. The recording of end of life choices and preferences are promoted to respect resident’s wishes. EVIDENCE: The four care plans sampled had been developed from the pre assessment documentation and included the resident’s care and support needs. The care plans were generally well written to allow the reader to gain an overview of the residents medical, social and personal care needs including complexities in communication and behaviours. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 13 It was observed and discussed during the inspection and the final feedback that the care plans were written in the form of nursing tasks and had not, as yet, been more fully developed to include written guidance on how residents are supported to maintain their skills including independent living skills, to identify their goals and work towards achieving them. For example one care plan stated for the staff to ‘ensure oral hygiene’ yet the inspector was advised that the resident was able to clean their own teeth and the object of reference was to offer them their tooth brush and support them through the process with reassurance and encouragement from staff. During discussions with the service owner, manager and head of care they demonstrated a commitment, in keeping with the homes objectives, to provide a more person centred approach to care and support residents to continue to maintain their existing skills regarding their personal care. The care plans included each residents health profile, nursing and dietary requirements including body weight charts which are monitored regularly to indicate weight loss or gain, skin integrity, safe moving and handling procedures, the residents current mobility, communication and sensory abilities, medication requirements, specialist care, and day and night time choices and preferences. There was clear documented evidence that regular and appropriate health care appointments including visits by the General Practitioner (GP) had been attended either in the home or by visiting the local health care services. During the inspection the inspector observed that a physiotherapist visited a resident at the home and through sampling care plans and observation it was evident that the home maintains good working partnerships with health care professionals which include visits from the opticians, dentists and chiropodists to ensure that residents health care needs continue to be met. Care records were professionally written and generally well maintained to reflect the individuals needs and care provided however some areas of improvements have been required and were addressed with the manager which included that the staff must make sure that all care plans are signed by the resident or their representative, that care plans are dated, and the plans kept under review to reflect any changes in the residents care and support needs. Following the inspection the commission have been advised by the manager that prompt action had been taken to address the shortfall identified. One care plan sampled contained a completed risk assessment, which indicated that the resident was at risk of falling and had had a fall several days prior to the inspection. The care notes detailed what actions staff had taken to minimise further falls, which included increased supervision of the resident. The risk assessment regarding the residents susceptibility to falls had not been updated to reflect the fall and the injury sustained and the care plan records regarding pain/wound assessment had not been updated to reflect if the resident had received any increased pain relief. This was brought to the Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 14 manager’s attention and discussed with the nurse in charge during the feedback at the final stages of the inspection. It has been required that risk assessments must be kept under review to reflect any changes in the residents care and support needs to ensure their safety and welfare. Other risk assessments were seen and considered to be appropriate in order to promote independence whilst ensuring the person’s safety and wellbeing. Following the inspection the commission have been advised by the manager that prompt action had been taken to address the shortfall identified. The home has a medication policy and procedure in place and has been supplied with a monitored dosage system. The nurse in charge showed the inspector that the home has good, clear procedures in place for the monitoring and recording of all medicines administered and those entering and leaving the home. Records of controlled medication were sampled and checks made were accurate. Some medication administration charts were seen which were well documented, some contained the resident’s photograph and were clear to ensure that residents received their prescribed medicines. It was confirmed that qualified staff administer medication in the home and samples of signatures were evident in the medication folder. It was noted that some residents were prescribed medication to be given as required (PRN). Whilst speaking with the nurse in charge it was evident that there were no written guidelines regarding the administration of the medication and the decision was based upon the nurse in charge professional judgement. It has been required that when PRN medication is prescribed and administered that there are clear written guidelines and protocols to indicate that all reasonable and safe measures have been taken before the medication has been administered to safeguard the resident and staff from any allegations of harm and abuse. Following the inspection the commission have been advised by the manager that prompt action had been taken to address the shortfall identified. The nurse in charge explained that residents have a right to refuse their medication and told the inspector that the home promotes peoples rights to independence and where possible following assessments people would be supported to manage their own medication. Visitors to the home stated that staff members are very caring, kind, welcoming and friendly to residents and visitors. It was observed that residents responded favourably to staff and the staff demonstrated a knowledge and understanding of the residents welfare and support needs. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by staff however it was raised with the manager that awareness of the use of terms of endearment to promote trusting professional relationships used by some staff in the home may be viewed as over familiarity and it has been suggested that if terms of endearment are used these be Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 15 recorded in the residents care plan and discussed with the residents and their representatives. The home have a policy regarding death and dying and there is a section within the residents care plan that included residents and their representative’s wishes regarding the residents final affairs are addressed sensitively. The manager told the inspector that the home would be working with other health care professionals to plan the implementation of the Gold Standard Framework Programme in order to support residents and their representatives in the well planned provision of end of life care within the home. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People are able to make choices about their daily routines and enjoy and choose from a range of activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members. The home provides a healthy and balanced diet in a pleasant spacious dining area. EVIDENCE: The home has two activities organisers on of which works part time. Several residents were seen, during the day to be sharing time with the activity coordinator on a one to one basis and also sharing coffee time. Some residents were in the lounge area of the home reading daily newspapers, or magazines, doing jigsaw puzzles and talking with staff. The home has promoted an activities programme which includes a range of activities and entertainment for residents and it was evident through observation that residents are asked if they wish to attend activities demonstrating preference and flexibility of the homes routine. Records of the activities or meaningful engagemnents of residents were well documented in Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 17 individuals care plans and there was evidence that each resident receives a documented plan of the homew weekly activities. Photographs of the PAT dog visits and other activities were displayed in the home activities room which had been well designed and decorated with historical advertisements, pictures and ornaments. The home are in the process of developing a life history/book for residents, if they choose, which would include gathering and sharing information with resident relatives and friends. The inspector sampled one document that included family photographs of significant events and was informative in providing the reader with an insight into the life of the resident in order to get to know the individual better. Visitors to the home confirmed that there are a variety of activities available in the home and that staff are flexible in allowing residents to choose the level of activities they attended. Several residents were excited to see deer in the garden during the inspection and told the inspector that they thought the gardens were lovely, one resident showed a particular interest for bird watching and like the fact that the home has some bird boxes and feeders. The owner of the home showed commitment to the promotion of meaningful reminiscence with the proposed development of rummage boxes, more ornaments and areas of particular interest throughout the home. The home has a well equipped sensory room that residents are free to use with supervision. The room contained some sensory equipment and objects and was furnished with comfortable settees and armchairs. In addition a small kitchen near the activities room is available for residents who, with support are free to make drinks and snacks if they choose. The AQAA advises that links have been maintained with the clergy who are free to visit the home and support resident’s spiritual and religious needs. During the inspection the homes hairdresser visited the service and several residents had their hair dressed. The home has a separate hairdressing room, which is well equipped to offer comfort and safety to residents. It was observed that the residents enjoyed the banter with hairdresser and liked the results of their hairstyles. The manager explained that further improvements to the hairdressing saloon would include the use of background music, magazines, coffees/teas, hairstyle pictures and magazines etc to enhance the atmosphere and environment of the saloon. The midday meal served at lunch time was well presented with each resident being able to sit up to a dining table to have their meal. The dining room was bright and spacious with appropriate crockery and condiments available on each table. A menu was available for residents to see what was on the days menu and several residents said that they really enjoyed the food served and looked forward to meal times. One resident told the inspector that the staff Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 18 had listenned to their concern about the choice of meals served and that things had got much better. The homes chef showed a commitment to talk to residents about their meals and their preferences with one resident telling the inspector that they had never eaten vegetables until they came to the home and would only eat the fresh vegetables prepared by the chef. Staff were attentive to residents during the meal time and served the meals and after dinner tea/coffees with cortesy and respect. It was noted that a bowl of fruit was available in the dining area and throughout the inspection residents were able to have a variety of soft drinks and tea and coffee. One resident told the inspector that they have residents meetings so that they can say what they like about the home and things ‘get done’. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents are protected by the homes complaints and safeguarding adults procedures and peoples legal rights are protected. EVIDENCE: The home has an established complaints procedure. The managers advised that all complaints received by the home are fully investigated and that records would be kept by the home to evidence this. No complainant has contacted the Commission with information concerning a complaint made to the service since the home was granted registration in January 2008. Several residents told the inspector that they were confident that the manager or staff would deal with any concerns or complaints they may have. The manager explained that some residents use the services of an advocate and the home promotes the resident’s rights to access any independent advocacy service. Staff training is being further developed to include staff awareness of the Mental Capacity Act and the home recognise residents rights to participate in the political process if they choose to. Records sampled indicated that some staff had attended safeguarding vulnerable adults training and for newly recruited staff this had been included in the induction programme. The home has a whistle blowing procedure and Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 20 records sampled indicated that Criminal Record Bureaux checks (CRB) and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. The home has a copy of the Surrey and Hampshire County Council Multiagency Procedures for Safeguarding Vulnerable Adults and the manager advised that the Buckinghamshire protocols had been sought. No safeguarding referral have made since the home was granted registration in January 2008. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is excellent. This judgement has been made using a range of evidence including a visit to this service. The physical layout and indoor and outdoor communal of the home enable people who use the service to live in a safe and well-maintained environment. Individual’s independence is promoted and maximised using specialist equipment. Individual’s bedrooms suit their needs and the communal bathrooms and toilets are adequate in number. All areas of the home are clean and hygienic. EVIDENCE: As previously documented the home was granted registration in January 2008 and the homes environment has been specially designed over two floors to create a pleasant and safe home for people with dementia and is fully equipped to support people who use wheelchairs or other mobility aids. A handy person is employed to ensure that the home is well maintained and records of work undertaken and in progress were sampled and evidenced that Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 22 the home continues to be well maintained. Following the completion of the building the inspector was advised that the site manager is still involved in the buildings with some decorative work still taking place. The homes indoor areas were well maintained and furnished to a high standard. The lounge areas included armchairs, settees, which were assembled into small clusters to enable residents to meet in small groups if they chose to. Attractive and homely fireplaces were situated in the lounge area and the soft furnishings of carpets, curtains and homely ornaments had been tastefully considered. The lounge area is fitted with a hearing loop system and a large screen television and there are facilities for residents to listen to music The dining areas were well equipped and offered a comfortable and attractive area for residents to enjoy their meals. Outdoor communal areas included an accessible enclosed sensory garden, which contained wide pathways, a water feature, objects of interest, sensory and aromatic plants and attractive sturdy garden furniture, which residents could use. The corridors of the home are wide and suitable for residents who use wheelchairs. There are aid to memory signs on the walls which include directions to the dining and lounge areas and image signs on the doors to the numerous toilets and bathrooms situated throughout the home. These facilities were well equipped with aids and adaptations and were clean and spacious to provide support and care for residents. Residents spoken with said that they liked their bedrooms, which were viewed during the tour of the premises to be clean, well decorated, furnished with a high standard of furnishings and were personalised. Residents can choose to have their names and photos on their bedroom door if they wish to. Prospective residents are encouraged to bring their own small items of furniture, which can help them to settle into a more familiar environment. The home has installed security key pad systems throughout the building in order to ensure residents safety and security. The home has an infection control policy in place and staff are trained and aware in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands and using hand gels to prevent the spread of infection in the home. There is a daily cleaning schedule in place and the home was exceptionally clean and odour free throughout, which also included the homes main kitchen. Visitors and residents commented that the standard of cleanliness and hygiene was very good. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home has a robust system for the induction, and training development to ensure peoples needs are met appropriately and safely. Management of recruitment files needs to be strengthened. EVIDENCE: The home is currently supporting 11 residents and have a total of 30 staff which include several registered general nurses and registered mental nurses, care assistants, bank staff, a qualified chef and assistant, activities coordinators, a handy person and the housekeeping staff. The staffing numbers on the day of the inspection were observed to meet the current needs of the residents and staff were at hand promptly to support residents who required immediate assistance. Visitors to the home on the day of the inspection spoke highly of the staff and how friendly and welcoming the home was. It was observed that the home employs a multi-cultural workforce and equality and diversity issues are addressed within the homes polies and procedures and induction programmes. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 24 The inspector sampled three staff recruitment files. Two of the three staff files evidenced that the home in general undertakes safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home yet there were some shortfalls which included the lack of photo identity in two files and for another file the references for the staff member could not be located. The inspector was assured that the references had been attained before the person commenced work and that the registered manager would locate the documents as a matter of priority. The staff mandatory training records were sampled and evidenced that the home is committed to the ongoing training and development of staff and works closely with a local care association in order to ensure that the homes staff are suitably trained and competent in their duties. The records indicated that the majority of staff had undertaken the necessary induction training and mandatory training and where training needed to be attended the training sessions had been booked. The AQAA advises that the service is committed to staff achieving a 50 level of the National Vocational Qualification (NVQ) in Level 2 or above. The home had a relaxed atmosphere and staff were observed to undertake their tasks in a quiet and orderly manner. The inspector observed staff interactions with residents all of which were supportive and friendly. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is robust to ensure the safety and wellbeing of residents. Residents are consulted regarding the running of the home and their health and financial interests are safeguarded. The health and safety of all persons in the home is promoted and robust policies and procedures are in place. Individual staff supervision needs to be implemented. EVIDENCE: Miss Watson attended a fit person interview on 18th December 2007 during which she demonstrated a high level of competency and knowledge in the running of a large nursing home and of her role and responsibilities as a registered manager. She was subsequently registered as the day to day Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 26 manager of the home. She has several years experience at senior management level and has been registered as a manager with the CSCI for two large services for older people with dementia in 2004 and again in 2006. She holds an registered mental nurse qualification and has achieved her National Vocational Qualification (NVQ) Level 4 Registered Managers Award. She has also undertaken numerous courses relating to the care of older people including dementia care mapping and person centred care through the university of Bradford. During the inspection she discussed the needs of the residents and demonstrated a good understanding of differing needs of older people with dementia and the support and care required through a person centred approach to care planning. She discussed the aims of the service in relation to the statement of purpose of the home and has been involved with formulating some policies and procedures for the service and also in devising the programme of planned training for the staff team. She continues to be fully involved in the recruitment of the staff team and discussed the importance of having a welltrained, motivated staff team in order to deliver a quality service. It was observed that her management style was open and approachable and acknowledged that all peoples views and opinions associated with the service should be listened to and acted upon where appropriate. The inspector was informed that the Regulation 26 visits take place and any shortfalls in the quality of the service would be noted by the organisation during the Regulation 26 visits, so that appropriate action could have been taken to rectify the shortfalls. There were clear lines of management accountability during the day of the inspection and staff demonstrated an understanding of their roles and responsibilities. All persons spoken with during the inspection spoke highly of the abilities and knowlegde of the manager and her open approach and the staff morale was good. Some residents financial records were sampled and these were well recorded and clear in evidencing that appropriate safekeeping and regular auditing of the accounts was undertaken in order to safeguard residents from financial abuse. The policies and procedures of the home and organisation were sound and staff demonstrated that they were aware of the core policies and procedures of the home, which included the health and safety policy to ensure that the welfare and safety of all persons in the home is promoted. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 27 The manager explained that she had not started to undertake staff individual supervision but had held staff meetings and met with staff during their induction and ongoing training programme. She was aware of the improtance of individual supervision with staff and assured the inspector that formal supervision would be planned. Records indicated that health and safety checks are maintained, fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. The home have maintained records relating to water and food temperature checks to ensure residents safety and well being. The home has the required gas safety and electrical certificates available in the home and a current insurance indemnity certificate confirmed to have been displayed in the homes main foyer to replace the certificate, which had expired the day before the inspection. The inspector re affirmed the procedures that the home must report any incidences to the CSCI under Regulation 37 notifications of any event that affects the well being and welfare of residents in the home as a notification had not been received by the commission at the time of the completion of the report. Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 18 3 4 4 4 4 4 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 3 3 3 Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15.(2)(a) (b)(c)(d) Requirement All care plans must be signed by the resident, or their representative, dated, and kept under review at least once a month ,to reflect any changes in the residents care and support needs. Risk assessments must be kept under review to reflect any changes in the residents care and support needs to ensure their safety and welfare. Arrangements must be made that when PRN medication is prescribed and administered that there are clear written guidelines and protocols to indicate that all reasonable and safe measures have been taken before the medication has been administered to safeguard the resident and staff from any allegations of harm and abuse. Timescale for action 02/08/08 2 OP7 13. (4)(b) (c) 02/08/08 3 OP9 13. (6) 02/08/08 Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holly Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lodge Nursing Home DS0000071413.V365351.R01.S.doc Version 5.2 Page 32 - 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!