Inspection on 24/10/05 for Hollymere House General Nursing Home

This inspection was carried out on 24th October 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hollymere House General Nursing... 14/09/07

Hollymere House General Nursing... 28/06/06

Hollymere House General Nursing... 05/07/05

Hollymere House General Nursing... 11/10/04

Hollymere House General Nursing... 08/06/04

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 Hollymere House General Nursing Home Crewe Road Haslington Crewe Cheshire CW1 1QZ Lead Inspector Wendy Smith Unannounced Inspection 24th October 2005 07:15 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 Hollymere House General Nursing Home DS0000018737.V260427.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. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hollymere House General Nursing Home Address Crewe Road Haslington Crewe Cheshire CW1 1QZ 01270 501861 01270 585043 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) Southern Cross Healthcare Services Limited Gillian Bratt Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48), Physical disability (2) of places Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 service users to include:* Up to 48 service users in the category OP (old age not falling within any other category) * Up to 2 service users in the category PD (physical disability) aged between 60 and 64 years The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 5th July 2005 2. 3. Date of last inspection Brief Description of the Service: Hollymere House is a modern two-storey property that was purpose built as a care home for older people. It is set in its own grounds, which are shared with the neighbouring Primrose House nursing home. The homes are in the Haslington area of Crewe close to local amenities and within reach of Crewe town centre. The homes are owned by Southern Cross Healthcare Ltd. Hollymere House has 48 single en-suite bedrooms and there are two lounges and a dining room on each floor. Bathing facilities are provided on both floors and a nurse call system is installed in all areas. There is ample parking space within the grounds. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out during the mornings of Monday 24th October and Thursday 27th October 2005. 46 residents were living at the home, of whom 34 were receiving nursing care and 12 receiving personal care. One resident had been admitted to hospital. A tour of the building, including communal areas and some bedrooms, was completed. Time was spent in conversation with the home manager and with other members of staff. Several residents and a relative were also spoken with. Staff training records, Health and Safety records, and arrangements for the handling of residents’ money were inspected. What the service does well: What has improved since the last inspection? The manager has moved to an office adjacent to the main entrance and is now more easily available to speak to visitors arriving and leaving. Regular staff meetings are being held to improve communication within the home. Suitable moving and handling equipment is available on both floors. General tidiness has improved. The home has a new head chef. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 6 New care plans are being written. A programme of staff training is being implemented. The manager has been registered with the Commission for Social Care 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. Hollymere House General Nursing Home DS0000018737.V260427.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 Hollymere House General Nursing Home DS0000018737.V260427.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): 3 and 4. Prospective residents are assessed prior to admission to determine whether the home can meet their needs. Residents whose needs can no longer be met at the home are re-assessed. EVIDENCE: Care plans contained evidence that all prospective residents are assessed by the home manager prior to admission being arranged. Written details of the assessment are in the care plans for staff to refer to. A resident who was in need of specialist care has moved to a more appropriate service following re-assessment. Hollymere House General Nursing Home DS0000018737.V260427.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): 10. More attention is needed to promoting the dignity of residents in daily living. EVIDENCE: Southern Cross Healthcare has developed a new care plan format that is colour-coded and is easier to follow. At the time of the inspection, nurses and senior care staff were in the process of writing new care plans in the new format for all residents. This was being carried out with consultation with residents and their relatives. The care plans will be inspected at the next inspection of the home. At the last inspection a number of personal care issues were raised with the inspectors by relatives and by a senior member of staff and, in general, the relatives spoken with considered that, whilst there were no major issues regarding care, there was a lack of sensitivity and attention to dignity and personal choice in the way in which care was provided. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 10 The manager has made efforts to address the shortcomings and it was pleasing to see residents sitting in the small lounge on the ground floor, although they had been left sitting in wheelchairs and not transferred into armchairs. The manager is holding daily meetings with senior staff and said that she is closely monitoring standards of tidiness in communal areas and in residents’ bedrooms. A hoist that had been awaiting repair for several months has now been repaired so that there is appropriate handling equipment on both floors. A programme of staff training and staff supervision, focussing on improving the quality of life for residents, is being followed. Nursing staff have been given the responsibility of ensuring that all residents receive the correct continence products that have been prescribed for them. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 11 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): 12, 13, 14 and 15 Social activities, to enhance the quality of life for residents, could be improved. Relatives may visit the home at any reasonable time and are involved in the care. The standard and choice of food needs to be improved. EVIDENCE: At 7:15am several residents were up, washed and dressed, but most were in bed. Two ladies spoken with said that they always liked to get up early and that they had been given a cup of tea. Members of the night staff were spoken with. They knew which residents like to get up early and told the inspector that they only got up those who wished to get up early before they go off duty at 8am. Other residents had been checked and changed as needed. The social activities programme displayed was from three weeks before. A number of trips out were arranged and activities such as arts and crafts and chair-based exercises were taking place. Activities are orientated towards the more able residents who are able to join in group sessions. The home has a part-time activities organiser and a second person was recruited in order to provide more diversity, but unfortunately was not considered suitable for the Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 12 post. A new brochure produced by Southern Cross states that all homes have access to a fleet of specially adapted minibuses. The manager said that she was not aware of this and that the home has to hire a minibus for trips out. See recommendation New arrangements have been made for hairdressing so that it is no longer carried out in the staff room. Some residents were having breakfast in the first floor dining room but most had breakfast in their bedrooms. Residents who had been up early had to wait until 9:20 for their breakfast. A resident who needed assistance with her breakfast was assisted by a member of staff who was also serving out the meal for the other residents on this floor at the same time. There was a food comments book in each dining room and these recorded both positive and negative comments about the meals. They were filled in regularly for the first week of implementation, but infrequently thereafter. Residents spoken with not very satisfied with their meals. The choice for lunch on the first day of the inspection was pork steak or corned beef salad with semolina for pudding. For the evening meal it was tomatoes on toast or sandwich. The manager said that she is continuing to monitor the food and plans to introduce better variety on the menus. See recommendation The carpet in first floor dining room is badly marked. See recommendation Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 13 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): 18 The home has policies and procedures relating to abuse, but staff training has not yet been carried out. EVIDENCE: Southern Cross Healthcare has policies and procedures relating to abuse. These are in line with the ‘No Secrets’ guidance. The manager said that staff training records were incomplete with relation to Adult Protection training and dates are arranged to provide this training for all staff before the end of the year. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 14 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 and 26 The home is refurbishment. in need of some redecoration and bathrooms require The standard of cleaning could be improved. EVIDENCE: A tour of the home showed that it was generally well-maintained and most areas are decorated and furnished to a good standard. All areas of the home are spacious and accessible to wheelchair users. Some of the window panels contained condensation and have been identified as needing replacement for several months. See recommendation The first floor corridor is in need of redecoration. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 15 See recommendation The home has five bathrooms and a shower room. All of the baths are very low level and are therefore difficult for staff as they involve a great deal of bending in order to assist residents. Three of the baths do not have any bathing aids. Bath panels are damaged. One bathroom has been taken out of use as the bath panel was in a dangerous condition. See requirement Bathrooms have no natural ventilation and there was a problem with bathrooms becoming over-heated during the summer, which resulted in residents being unable to have a bath as it was too hot. Ventilation in other areas of the home also presented problems during hot weather. See requirement All bedrooms are single and have en-suite facilities. Bedrooms were seen to be appropriately decorated and furnished and some were personalised with residents’ own belongings. The laundry is clean and orderly. At the time of the inspection the home employed only two part-time cleaners. There had been only one cleaner on duty for the last four days and the general appearance of the home reflected this. Areas such as window ledges and skirting boards had not been cleaned. A number of wheelchairs needed cleaning. A number of bins were full and did not have lids. Recruitment was taking place for more cleaning staff. Cleaning schedules have been introduced recently. See recommendation Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 16 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): 27 and 30. Staff are provided in sufficient numbers to meet the needs of residents. Skill mix on night duty is under review. A programme of staff training is being implemented. EVIDENCE: During the night there is one nurse and four care staff on duty. The nurse has to administer medicines prescribed for all of the residents on both floors of the home at night, and to make entries in care plans for all residents. This was discussed with the manager who confirmed that she intends to employ senior care assistants on night duty as soon as suitably trained staff can be recruited. Examination of staff rotas and signing in sheets showed that staff are supplied in sufficient numbers to meet the needs of residents, however it was noted that a significant number of staff work in excess of 48 hours on regular basis. The manager said that she hopes to be able to appoint a care manager to work alongside staff and supervise care practice. Staff time sheets provided evidence that moving and handling, and food hygiene training had been provided during the month of October. It is intended that two staff from the home will train to be moving and handling instructors. Abuse training is planned for five dates during November and December to ensure that all staff are able to attend. Staff have also attended training events provided by the Primary Care Trust. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 17 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): 31, 33, 35 and 38. The home is managed by an experienced manager who is registered with the Commission for Social Care Inspection. Progress is being made to promote greater satisfaction among residents and their relatives. The home does not handle residents money except for personal spending money. Arrangements are in place to safeguard the health and safety of residents and staff. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 18 EVIDENCE: Since the last inspection, the home manager has been registered with the Commission for Social Care Inspection. She is nearing completion of the Registered Managers Award. The manager has moved to an office adjacent to the main entrance and is now more easily available to speak to visitors arriving and leaving. The manager is making efforts to address areas where dissatisfaction was expressed at the time of the last inspection. A meeting was held for all nurses the week before the inspection, and a daily meeting is being held each morning with senior staff. Staff members are having one to one supervision sessions with the manager. The manager said that she is closely monitoring standards of tidiness in communal areas and in residents’ bedrooms. A hoist that had been awaiting repair for several months has now been repaired. A programme of staff training and staff supervision, focussing on improving the quality of life for residents, is being followed. Nursing staff have been given the responsibility of ensuring that all residents receive the correct continence products that have been prescribed for them. The home has an administrator who deals with day to day finances in the home. She has been in post since February 2005. The home does not handle any residents’ finances other than small amounts of personal spending money. Receipts are provided for all money received and paid out. Residents money is kept in the safe in individual envelopes. Electronic records of all transaction are maintained. The home was inspected by the fire officer in September 2005 and work identified at a previous inspection had been completed. The maintenance person tests the fire alarm weekly and the emergency lighting two-weekly. He provides fire training as part of the induction for new staff. Fire training was provided for all staff in April in May and the next is due in November 2005. A monthly accident audit is sent to central office. This requires a detailed breakdown of all accidents reported during that month. Maintenance records inspected showed that all plant and equipment in the home had been tested and serviced as required. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 19 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 x 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP21 Regulation 23 Requirement Bathrooms must be improved to meet the needs of residents requiring assistance. The ventilation of the home and in particular the bathrooms must be improved. Timescale for action 31/12/05 2 OP25 OP21 23 31/12/05 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 4 Refer to Standard OP12 OP15 OP19 OP26 Good Practice Recommendations Activities should be provided to cater for the differing needs of individual residents. The standard and variety of meals should be improved. Window panels should be replaced as needed. Additional cleaning staff should be recruited to improve the standard of cleaning. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 21 5 6 OP19 OP19 The first floor corridor needs to be redecorated. Dining room carpets should be thoroughly cleaned or replaced if they do not clean to a good standard. Hollymere House General Nursing Home DS0000018737.V260427.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. 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