Inspection on 14/12/05 for Hollybush House Nursing Home

This inspection was carried out on 14th December 2005.

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

Hollybush House Nursing Home 17/10/06

Hollybush House Nursing Home 03/08/05

Hollybush House Nursing Home 20/12/04

Hollybush House Nursing Home 14/07/04

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

CARE HOMES FOR OLDER PEOPLE Hollybush House Nursing Home Corbett Hospital Vicarage Road Stourbridge West Midlands DY8 4JB Lead Inspector Mrs Amanda Hennessy Unannounced Inspection 14th December 2005 12:30 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 Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 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. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hollybush House Nursing Home Address Corbett Hospital Vicarage Road Stourbridge West Midlands DY8 4JB 01384 442782 01384 444734 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) Shaw healthcare Limited Filipe de Pina Muller Care Home 24 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (22) of places Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 2 Beds for Dementia Care aged 58 years and over. One service user identified in the variation application dated 23.11.04 may be accommodated at the home in the category LD(E). This will remain until such time that the service users placement is terminated and whilst the home is able to meet her needs. 3rd August 2005 Date of last inspection Brief Description of the Service: Hollybush House is a purpose built, single storey nursing home for the elderly with dementia. Hollybush is privately owned by Shaw Homes. The home has a large open lounge and dining area, a small quiet lounge, activities room and activities kitchen. Televisions and a stereo system are provided in the main lounge, with televisions also available in some service users bedrooms. The home has a secure garden with patio area, which is available for all service users. The home is welcoming with flowers, pictures and ornaments on display. A qualified nurse is on duty twenty-four hours a day, with a Registered Nurse (mental health) available usually on at least one shift during a twentyfour period. The home was designed with service users possible disabilities in mind, and includes wheelchair access, handrails, assisted baths and other adaptations. A full laundry service is also provided free of charge. The home is located in the grounds of Corbett Hopsital and has car parking available at the side of the home. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspection was undertaken by two Inspectors Mrs Mandy Beck and Mrs Amanda Hennessy between 12.30 and 16.30. The inspection included a tour of building, a review of records, talking to visitors, service users and staff. Care records were reviewed as part of the “case tracking” of four residents. Hollybush Nursing Home is privately owned by Shaw Homes, The home’s manager is Mr David Lo. Three of the previous ten requirements were found to have been addressed, nine new requirements were made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: The home provides adequate care for people with dementia but could and must take steps to provide excellent care and become a centre of excellence for providing dementia care. The premises need to be updated to reflect the needs of people with dementia following the advise of a Dementia Care Specialist. Care plans need to accurately identify the service users mental health and social needs. All staff require additional training that is preferably accredited in caring for people with dementia to give them greater awareness and understanding of their needs. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 6 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. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 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 Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Service users admitted for intermediate care do not consistently receive appropriate care to maximise their independence. EVIDENCE: The home is currently undertaking a trial to accommodate up to two service users who require intermediate care. Service users requiring intermediate care are assessed and reviewed by a multi-disciplinary team both prior to their admission and agreement of their long term care needs. Staff at the home have also received training into “What is Intermediate care” despite this there is a general lack of awareness and clarity of the needs and support for intermediate care service users. Care records for intermediate care service users do not identify that their care is any different from long term service users. Service users requiring intermediate care are not separate from long term service users and they are not cared for by a separate staff group, although this will be undertaken if agreement is made to continue with the intermediate care contract. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Care is generally satisfactory but omissions in care records compromise the health and well being of service users. EVIDENCE: Care records require development, with a need particularly to identify service users mental health problems and social needs. Service users’ abilities and cognitive functioning are not identified which if undertaken would enable staff to effectively plan their care. Staff must explicitly identify how needs are met rather than stating “can be aggressive at times”. Care records identified one service user who had lost weight since admission, however no plan of care to address this weight loss was available. Service users identified at risk of dehydration and poor dietary intake had no record of their dietary and fluid intake. The home have a number of service users requiring and receiving a special diet although staff spoken to were unaware that one service user required a high protein diet and consequently were not receiving it. Care records were also found not to be reviewed as frequently as required. Medication records also identify a need for development see requirements list. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Services users choices are not fully explored. It is not evident that restrictions in place are in the service users best interests. EVIDENCE: Unfortunately due to the nature of advanced dementia the service users ability to express choice is very limited and relates to simple choices such as personal activity and nutritional requirements. It was pleasing to see that service users had been able to bring in familiar and cherished personal possessions which adorn their bedrooms. Staff had dressed one service user in their trousers back to front due to their challenging behaviour, there was no record of this within their care plan or any record of any multidisciplinary agreement to it. Staff confirmed that service users have a meal choice at each mealtime. The choice of soft diet is limited especially at teatime with staff stating that they frequently pour the soup over the service users mashed potato. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed in this section during this inspection. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is clean, homely and generally free from offensive odours but does not reflect the needs of people with dementia. EVIDENCE: The home is clean, homely and welcoming. A slight mal odour was evident when Inspectors first entered the home but this was quickly addressed. There is a large lounge/ dining room with smaller areas off the main lounge a small quiet lounge is also available. The home has a full nurse call system and a variety of aids and adaptations such as grab rail assisted baths and a wheel in shower available for dependent residents. There is a nothing presently to identify how the environment of the home acknowledges and addresses the needs of service users with dementia who have limited comprehension and poor memory. The home has satisfactory infection control procedures to safeguard the service users. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Training opportunities are good but staff still require training in dementia to ensure that they understand and are competent to care for service users. EVIDENCE: Staff have good training opportunities. All staff receive induction training to National Training Organisation specifications and at least three training days each year. There is a need for staff to undertake training and regular updates in the awareness of the needs of people with dementia and the management of challenging behaviour including violence and aggression. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 Service users financial interests are safeguarded. EVIDENCE: Secure facilities are available for the safe keeping of service users personal money and valuables. Written records are available for all transactions which detail the reason for the withdrawal and two signatures, receipts are available as proof of purchases. Regular external audits of service users personal money are undertaken. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 15 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 x x x x x 1 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x x Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 16 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 OP6 Regulation 12 Requirement Intermediate care service users are accommodated separately and have a separate staff group to long stay service users. Care plans must identify mental health needs and must be reviewed monthly or as clinically indicated. Involvement of service users or their representative must be evidenced in the drawing up and review of the care plan wherever possible. Partially met- care plans do not always identify mental health needs and are not always reviewed monthly Service users identified at risk of dehydration and poor dietary intake must have a record of their dietary and fluid intake. The home have a number of service users requiring and receiving a special diet although staff spoken to were unaware that one service user required a high protein diet and consequently were not receiving it. All residents have a plan of care DS0000004877.V273145.R01.S.doc Timescale for action 31/03/06 2 OP7 15 31/12/05 3 OP7 15 15/12/05 4 OP7 15 31/01/06 Page 17 Hollybush House Nursing Home Version 5.0 5 6 7 8 OP9 OP9 OP9 OP9 13(2) 13(2) 13(2) 13(2) 9 OP14 12 10 11 12 OP15 OP15 OP15 15 16(2)(i) 13(6) 13 OP22 23 14 15 OP31 OP36 9 18 for their social needs. Not met A date of opening must be recorded on all short life items. Not met The exact amount given of variable dose medication must be identified Care plans must be available for medicines that are administered on an “as required” basis. There must not be any gaps in the medication administration record. The reason for the non administration of medicines must be identified. Restrictions in service users lives within the home must be agreed on a multidisciplinary basis, with a record of this agreement within the care records. Service users requiring a special diet must receive it. Meal choices for “soft diets” must be reviewed. Staff must receive training in the awareness of abuse. Partially met- a training programme for all staff in the awareness of abuse has been identified. Partially met- Care staff have not received training. An assessment of the premises and report of the assessment must be undertaken by a person with a specialist knowledge of dementia. The home must provide an action plan to meet the recommendations identified within the report. The registered provider must forward a proposal for a registered manager at Hollybush. A supervision system is implemented, ensuring care staff receive a documented DS0000004877.V273145.R01.S.doc 15/12/05 15/12/05 31/12/05 15/12/05 31/12/05 15/12/05 31/12/05 31/03/06 28/02/06 31/10/05 31/01/06 Hollybush House Nursing Home Version 5.0 Page 18 16 OP38 18(1) supervision session at least six times every year Partially met- A supervision system has been identified and has been commenced but not all staff receive supervision regularly. Staff must receive training in the care of people with dementia, management of violence and aggression de-escalation techniques and first aid. Not met. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP14 OP22 OP30 Good Practice Recommendations Information on advocacy is displayed within the home The use of pictorial signs (for toilets and bathrooms etc) and colour for people with dementia is explored. Staff receive accredited dementia care training. Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hollybush House Nursing Home DS0000004877.V273145.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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