Inspection on 31/05/07 for Hollybank Nursing Home

This inspection was carried out on 31st May 2007.

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

Hollybank Nursing Home 20/01/10

Hollybank Nursing Home 20/01/09

Hollybank Nursing Home 28/05/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Hollybank Residential Nursing Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN Lead Inspector Stuart Horrocks Unannounced Inspection 08:30 31st May 2007 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 Hollybank Residential Nursing Home DS0000068886.V334506.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. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hollybank Residential Nursing Home Address 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN 0161 723 5756 0161 724 9693 hollybankdualreg@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) QNS Residential Limited Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code 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 - Code OP, The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief Description of the Service: Hollybank is operated by QNS Residential Limited. The home provides 24-hour care for up to 30 older people. The property is on Bolton Road Radcliffe and is about one mile from the town centre. There is a bus stop on the main road close to the home and there are shops nearby. The accommodation is provided on two levels with a lift giving access to the first floor. The home has fourteen single bedrooms and eight rooms that are shared. Thirteen bedrooms have an en-suite toilet and hand basin. There are two lounges one of which has a conservatory attached and there is a separate dining room. Toilets and bathrooms are provided on both floors. The home has a garden area with seating that can easily be reached from the conservatory. A Service User Guide that describes the home’s services is readily available in the home and the staff gives other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report, the home’s Statement of Purpose and a copies of the home’s policies and procedures are also displayed in the home. As of October 2006 the weekly charge for accommodation and services range from £355.11 to £367.00 with additional charges being made for hairdressing and chiropody services. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit that was started at 8.30am on the 31st May 2007. The home did not know that the inspector was going to visit. It took place over one day and it lasted for about eight hours. The time was split between talking to the proprietor, senior staff and checking records, looking around the home, watching what was happening and talking to residents, a relative and other staff. Four residents, one relative and four staff were spoken with. The home manager was not available on the day of this visit so the proprietor and a senior care worker assisted with the inspection. The home was registered to new owners (QNS Residential Limited) in February 2007; this was therefore the first full inspection of the home since the change of ownership. A completed provider’s self-assessment survey information document (Annual Quality Assurance Assessment) was received before the inspection. The care services (case tracking) provided to three specific residents were used a basis for the process of the inspection. Concerns about the home were made directly to the CSCI in March and May 2007. Individual issues arising from these concerns have been examined under the National Minimum Standards outcome groups “Health & Personal Care”, “Daily Life & Social Activities”, “Environment” and “Staffing” and they are commented upon in these sections of this report. What the service does well: Residents felt they were well looked after by the staff whom they described as “very good”, “nice” and “helpful”. The residents looked well cared for and throughout the inspection, the staff cared for the residents in a kind, caring and considerate way. The home’s visiting arrangements are flexible thus enabling the residents to have good contact with their family and friends as they please. The care practices in the home ensure that the residents are treated with respect and their privacy and dignity is upheld. The residents have choice about their daily routines, spending their time doing whatever they prefer. Where residents are unable to make choices the staff offer support in such a way that promotes the residents dignity and independence. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 6 The home offers some leisure activities, which help to keep the residents interested and stimulated. Hollybank provides clean, comfortable and homely and friendly surroundings for the people living there. 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. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Although the admission process is generally satisfactory, the home’s in-house procedures may not be sufficient to ensure that people’s diverse needs are always identified and planned for before they move in to the home and therefore the home cannot always be sure that it can meet their care needs. EVIDENCE: The home has both a Service User Guide (Residents Information Guide) and a Statement of Purpose that provide new and existing residents and their families with useful information about the services that the home provides. Copies of these documents were present in the resident’s bedroom and in the entrance area of the home. There is an expectation that new residents will have had their care needs assessed before they move in to the home so that they can be assured that the home can meet their needs. Such assessments are usually provided by the referring agency (e.g. a Social Services Department) or in the case where residents are paying for their care by the home’s assessment procedure. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 9 The care files of the three case tracked residents were therefore checked for the necessary pre-admission needs assessment information. The Social Services Department had funded the placements for two of these residents and the care managers had provided detailed assessments, which gave the reader a very clear picture of the persons needs. In the other instance the staff had used an in-house assessment procedure that does not appear to cover all of the care needs issues as required by sub-standard 3.3 of the National Minimum Standards. However, it should be noted the new owner has now introduced a comprehensive assessment document that does cover all of the above points that is intended to be used in the future. From the above information the home is then able to assess whether these people’s needs can be met and a care plan and a range of other care delivery information is then put together It should also be noted that in the above instance the placement has been satisfactory and the residents care needs have been met. The owner said that new residents and their families are welcome to visit the home where they can spend some time, meet the residents and the staff, and have a meal before deciding to live there. The inspector had previously been informed that a senior member of the care staff usually visits new residents either at home or in the hospital as a part of the pre-admission needs assessment process. However enquiries revealed that this is not always happening with at times such pre-admission needs assessments being undertaken by staff that are not care workers. The inspector considers this unsatisfactory in that such a person may not have the necessary skills to undertake such an assessment with the risk that errors in assessment may be made. The inspector therefore requires that needs of new residents be assessed by a suitably qualified or suitably trained person. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although individual care plans are in place, which were up to date and regularly reviewed, the staff must make sure that the residents are protected from unnecessary risks to their wellbeing. EVIDENCE: Information received before the inspection alleged that some identified residents care needs may not always be being fully dealt with, particularly in relation to falls and injuries that these people had sustained. The care of two of these particular residents and one other were therefore case tracked as a part of the inspection process. Examination of their care files showed that these contained recently revised care plans that had been kept up to date monthly as is required. The care plans are properly laid out and they are easy to read and follow. Each plan contained details of health, personal and social care needs for the resident and day and night progress reports about each resident are regularly recorded. As required up to date risk assessments were in place for mobility and nutrition with pressure sore risk being assessed by direct observation by the staff with Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 11 any problems being referred to the community nursing staff for advice and treatment. Each resident has a key worker who takes responsibility for ensuring that care plans and risk assessments are up to date and relevant. Examination of the home’s accident record showed that one of these residents had sustained a considerable number of falls. The home is aware of this issue with consideration being currently given to a reassessment of this resident’s needs with a view to referral to an alternative form of care. In the meantime the staff must further risk assess this residents needs and consideration must be given to seeking advice about how to deal with the number of falls occurring (E.G. a local falls clinic). Other information received before this inspection was about the possible inappropriate use of “bucket chairs”. Two such chairs were seen in one of the home’s lounges; these are deep-seated chairs that are difficult to get out of and may therefore be seen as a form of restraint. Caution must be used when using these chairs as inappropriate use can be construed as abuse. Such equipment should only be used in exceptional circumstances and when it is the only practicable means of protecting a resident’s welfare. The use of such equipment must therefore be both risk assessed and justified in the residents care plan. A further issue identified before the inspection was about the security of the home where two residents had got out of the home through a fire door. Although this particular door is alarmed the staff must assess this risk with if possible steps being taken to reduce this hazard. Another concern made before the inspection was that there was a lack of protective disposable gloves and aprons for the staff to wear and a shortage of incontinence cleaning materials. This allegation was not substantiated, checking of stocks showed that there was a plentiful supply of these products that are readily available to the staff. The home has a number of bed safety rails in use, as previously required the general condition, safety and safe attachment to the bed of these rails is checked daily with an up to date record kept The residents’ weight is regularly checked and talking to residents, the owner and the staff and looking at records showed that the resident’s health care needs are taken care of and that when necessary health workers such as doctors, nurses and opticians are called. All medicines were safely stored and lockable Controlled Drugs storage is also available and the random checking of these found the quantity kept corresponded as required with the amount recorded in the Register.. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 12 The residents’ medicines are provided in pre-filled cassettes and pre-printed prescription/recording sheets also provided. These records were found to be properly completed and to be up to date. The medications supplied are checked in to the home , and medicines returned to the pharmacy are also recorded. Identification photographs of each resident are kept with the medication administration records. Medicines are given out either by trained nurses or by senior care staff that have been trained in this task. No resident was dealing with his or her own medicines at the time of this inspection. In discussion the residents said that they are given their medicines regularly and as prescribed. The home’s Statement of Purpose states, “Carers will strive to preserve and maintain the dignity, individuality and privacy of all service users within a warm and caring atmosphere ”. Residents spoken with were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity was respected at all times. This was also observed during the inspection. The care assistants interviewed were able to give good examples of how they promoted privacy and dignity in their daily care routines, for example knocking on bedroom doors before entering. The residents said that the staff had a “kind and considerate” manner and that the staff spoke to them in a “civil and polite” way. The staff were seen to have a good relationship with the residents, speaking to them in a natural, thoughtful and warm manner. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities offered within the home mean that residents have opportunities to participate in stimulating and motivating activities. Whilst residents have choice about their daily routines, they need to be made more aware of the food available to them and their satisfaction with the food offered should be confirmed. EVIDENCE: Residents felt their routines were flexible and that they had choices in where to sit in lounges and dining room, whether or not to take part in activities, what to wear and times of rising/retiring. For those residents who may have a limited ability to make decisions and choices about their day-to-day living arrangements, the staff said that they try to assist them with this by offering choices about such things as what clothing to wear and when to rise and retire. The residents are able to, and do bring personal items in to the home such as televisions, radios, photographs, pictures and ornaments. The staff were seen to treat residents in a dignified,respectful and curteous manner and to deal with them in a friendly and natural way. The home has a five-day recreational activities programme that is displayed in various areas of the home. This programme list the following activities; bingo, Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 14 skittles, ball games, keep fit, dominoes, “play your cards right and sing-alongs. A part time activities coordinator runs the programme in the afternoon from Monday to Friday. Those residents spoken with were aware of the available activities although some chose not to join in. An outing to Radcliffe Carnival had been arranged for the Saturday following the inspection with a number of the residents intending to attend. A collective up to date record is kept of when residents have taken part in activities and the key workers individually record when someone has been involved in an activity. These entries showed that as well as listing the events from the main programme that residents have been taken out for a walk and that they have had one to one chats with their key worker. The home’s Service User Guide states that friends and relatives are welcome to visit at any time on any day. Residents and staff confirmed that visitors were made welcome in the home and were offered refreshments. Those residents spoken with said that they “were free to see their visitors wherever they wanted to”. Information received before the inspection alleged that poor quality meals are provided, that left over food is re-used, that sometimes food was kept warm for overlong periods and that no menu is displayed in the home. The new owner explained that a three weekly menu has been introduced that provides a substantial meal at lunchtime with a lighter meal being offered at teatime. A typical meal offered at lunchtime was fish, chips, peas and mashed potatoes, chicken roll salad as an alternative with fruit pie and custard as a sweet. An example from the teatime menu provided soup and sandwiches or pasties and ice cream. Those residents spoken with were generally satisfied with the food provided and they said that they got enough to eat. However, they did not appear to be aware of the food available or of alternatives to the main course. This is because the menu is currently not displayed in the home, the home must therefore make sure that the menu is made available to the residents and the staff should ensure that the residents are made aware of the choices and alternatives that are to be had. In discussion the staff and the relief cook (the chef was on holiday) vigorously denied the allegations described above that were not substantiated. In view however of the somewhat negative comments that were received before the inspection about the quality of the food provided, it is recommended that a short term monitoring of the residents satisfaction with the food offered is undertaken. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints system that ensures that concerns are properly dealt with and good protection of vulnerable adults guidance and staff training in this topic makes sure that residents are protected from abuse. EVIDENCE: The home has a good complaints procedure that states how a complaint is to be made, who to and that an initial response will be provided within two days with a final outcome forwarded within 28 days. The facility of making concerns known directly to the CSCI is also included in this paperwork. The complaints procedure described above is included in the Service User Guide as well as being displayed in the entrance area of the home. Discussion with residents and a relative showed that these people would have no hesitation in making their concerns known to the staff or manager, and they believed that their anxieties would be listened to and acted upon. The staff interviewed were clear that any complaints made by residents or relatives would be reported immediately to the manager or to senior staff on duty. The home has a proper record for writing down complaints; no entries have been made since 2004. But, as mentioned earlier in this report a number of concerns have been expressed directly to the CSCI in March and May 2007. Issues raised included allegations about the quality of the food provided, staffing levels, the personal care provided to residents, the cleanliness of the home and an alleged lack of certain equipment. Individual issues arising from Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 16 these concerns have been examined under the National Minimum Standards outcome groups as described under the Summary section of this report. There is written adult protection procedure and the home has a full copy of a nationally produced “Safeguarding Adults document. However the inspector recommends that copy of the local inter-agency adult protection policy and procedure be obtained so that local guidance is followed should an abuse situation arise All staff receives training on the protection of vulnerable adults during NVQ Level 2 training in care that has a unit on adult abuse with 10 staff having competed this instruction. Further staff training in this topic has also been provided in-house. Those staff spoken with demonstrated an awareness of the different sorts of abuse and they understood what they should do if they suspected that someone was being abused. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 17 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 and 26. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Hollybank provides comfortable and friendly surroundings for the people living there. However the home will benefit from the planned refurbishment work, which will further enhance the presentation of the home and will benefit the residents. EVIDENCE: Hollybank is generally well maintained both to the inside and to the outside. Furnishing in communal areas is currently to an adequate standard and is domestic in style. However the new owner intends to carry out a programme of considerable refurbishment throughout the home. Work planned for the immediate future includes the relocation of the hairdressing room so that a staff room can be created. The home’s laundry is to be moved from the basement to the ground floor of the home. The home’s two lounges, the dining room and a hallway, stairs and top landing are to be re-carpeted. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 18 Fitted units in the dining room are to be removed so creating more floor space with this room then being redecorated. New lounge chairs are to be purchased and a dishwasher has recently been installed in the kitchen. Information received before this inspection alleged that the standard of hygiene and cleanliness achieved in the home was poor that was to some extent due to a lack of cleaning staff a the weekend. The inspector’s tour of the building did not substantiate this allegation with the home found to be clean, tidy and free from offensive odours. Issues regarding the provision of domestic support staff can be found in the Staffing section of this report. The three case-tracked resident’s bedrooms and a number of others were checked. All were found to be generally properly decorated, furnished and equipped and to be clean and these residents were satisfied with the standard of the accommodation provided. There is good accessibility around the building with ramps, assisted baths and other equpment provided. Aids and adaptation are provided in bedrooms, bathroom and toilets and information regarding the control of infection is available. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Improvements in staff recruitment and training are needed to make sure that the residents are looked after by staff that are suitable to carry out care work. Evening time staffing levels need to be increased therefore making sure that the care and health and safety needs of the residents and the staff can be met. EVIDENCE: Looking at staff rotas showed that as well as employing care staff, the home also employs domestic, laundry, catering and maintenance staff. Information received before the inspection indicated that there was not always sufficient staff on duty to fully meet the residents care needs and that no domestic cleaning staff were available at the weekend. The staff said that the home tries to ensure that there are five staff on duty during the morning, three or four staff in the afternoon, three in the evening and three available overnight. The above figures include the manager’s duty hours. Looking at staff rotas for a two-week period in June 2007 showed that the above figures have usually been achieved although this has at times required overtime working and the use of agency staff. The home is presently recruiting care staff so the need for overtime and the use of agency workers will be reduced when these people are employed. In discussion the staff felt that three evening staff was inadequate but the four staff would be sufficient. The inspector is also of the opinion that three evening staff is not sufficient to enable the residents care needs to be fully met. The Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 20 inspector therefore requires that a minimum of four staff must be available at all times during the evening time. Two domestic cleaning staff are usually available in the home from Monday to Friday but none are routinely available at the weekend. The inspector considers this arrangement somewhat unsatisfactory in achieving appropriate levels of hygiene and cleanliness for all days of the week. It is therefore recommended that a basic level of staff cleaning cover is provided at the weekends. The home was required to have 50 of the care staff with NVQ level 2 care qualifications or above by the end of 2005. Of the 13 care staff employed at the home six have got a National Vocational Qualification at Level 2 or above and five others are working towards achieving this qualification. 47 of the staff are thus trained to the required level and when the six other staff have completed this training the required target will be met. The files of four recently recruited staff and one other were checked for the required safe employment information. These did not fully evidence a safe and proper recruitment system. All of the files contained a job application form, an up to date police check and two written references. But the required health declaration and proof of identity were not present and some applicants had not provided a fully detailed work history. It should be noted that the new owner of the home has recently introduced a more detailed job application form that now includes a section for a health declaration. However the home must make sure that full details about workers are obtained before new staff are employed therefore ensuring the safety of the residents. The home has a staff-training chart that shows both when training has been provide and when training is required. Looking at this chart showed that some of the required mandatory training (safe moving and handling, fire safety, and first aid) has been provided but that many staff needed training in infection control, health and safety and food hygiene. Much of the training provided at the home is done by the use of approved video programmes. Although the inspector considers this method of training to be adequate in most instances the inspector is of the opinion that moving and handling training should also include practical instruction and demonstration. This could be provided by a member of the home’s staff who would also need to be trained in giving this instruction. As required the home has recently acquired a training programme for the induction of new staff that complies with the nationally recognised Scils for Care Common Induction Standards. It is intended that in future this programme will be used for the introduction of new and inexperienced staff both to the home and to care work. Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 21 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): 31,33,35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home should undertake further training to ensure that the residents continue to receive a good standard of care and further staff training is needed in some health and safety topics so ensuring the welfare of the people using the service. EVIDENCE: The home has recently appointed a manager who has been approved and registered by the CSCI. Although the Registered Manager is a qualified nurse that has a “live” registration with the Nursing and Midwifery Council it is recommended by the CSCI that they undertake the NVQ4 Registered Managers Award that is the preferred management qualification for new managers. The new manager does not possess the relevant qualifications so this should be part of their individual personal development plan. They should be registered for the appropriate Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 22 qualifications within three months and have completed their qualification within two years. Both residents and staff said that the manager was approachable and would listen to any suggestions and comments. A requirement of Standard 33 is that care homes must use quality assurance systems that are largely based on seeking the views of residents, their relatives and visiting health care workers to measure the home’s success in meeting the home’s aims and objectives. In the early part of 2007 the home the home sought the views of GP’s, nurses and other health care workers by the use of survey questionnaires. Five survey forms were returned with all of them scoring positively for the questions that asked about how well the home is meeting the residents’ needs. The results of this survey have been brought together in the form of a brief report that should now be displayed in the home and the manager is reminded that at the time of the next survey the views of the residents and their families should be sought. The manager has also recently undertaken an internal quality audit of the home’s systems for items such as residents care plans, catering, laundry services and cleanliness. The inspector was informed that the home does not handle or deal with any residents’ personal monies and that no member of the staff is identified as an appointee with regard to residents’ pensions. Should the home need to deal with residents’ money then detailed records of financial transactions must be kept. The home is safely maintained with fire precautions tests done regularly, the details of accidents are properly recorded and hot water temperatures at sinks are controlled in such a way as to prevent accidental scalding. Random sampling of records and maintenance certificates showed that these were up to date and they confirmed that the home’s equipment, fixtures and fittings are regularly serviced. The examination of paperwork and conversations with staff also confirmed that they had been provided with the required training in safe moving and handling,fire safety and first aid and but that some staff needed training in infection control,health and safety and food hygiene topics. Hollybank Residential Nursing Home DS0000068886.V334506.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A X X 2 Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A 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) (a) Requirement The needs of new residents must be assessed by a suitably qualified or suitably trained person, so ensuring that the home can be confident in meeting these people’s needs. Residents with a history of falls must have their needs reassessed and if necessary advice sought so as to reduce the risk of unnecessary injury. Deep-seated recliner chairs must only be used in exceptional circumstances when this has been risk assessed and justified in their care plan, to reduce the risk of unreasonable and unnecessary restraint. The risk to residents presented by fire exits must be assessed to reduce the risk of these people leaving the home unbeknown to the staff. A menu must be made available so that the people using the service are aware of the choice of food that is to be had. A minimum of four care staff must be available at all times DS0000068886.V334506.R01.S.doc Timescale for action 16/07/07 2 OP8 13 (4) (c) 09/07/07 3 OP8 13 (7) (8) 09/07/07 4 OP8 13 (4) (c) 09/07/07 5 OP15 16 (2) (i) 17 (2) 18 (1) (a) 09/07/07 6 OP27 09/07/07 Hollybank Residential Nursing Home Version 5.2 Page 25 7 OP29 19 (1) (b) 8 OP38 13 (3) during the evening time, so as to ensure that people using the service are properly cared for. Staff must be safely and properly 16/07/07 recruited with all of the required checks being completed before they are employed, to ensure that workers who are suitable and fit to do this work care for the people who use the service. The staff must be provided with 31/08/07 training in the topics of infection control, health and safety, and food hygiene topics. Therefore ensuring that the people who use this service are not at risk from cross infection or any other form of risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations In view of the somewhat negative comments that were received before the inspection about the quality of the food provided, it is recommended that a short term monitoring of the residents satisfaction with the food offered is undertaken. It is recommended that copy of the local inter-agency adult protection policy and procedure be obtained so that local guidance is followed should an abuse situation arise It is recommended that a basic level of staff cleaning cover is provided at the weekends. It is recommended by the CSCI that home managers undertake the NVQ4 Registered Managers Award that is the preferred management qualification for new managers. 2 3 4 OP18 OP27 OP31 Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Hollybank Residential Nursing Home DS0000068886.V334506.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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